BY: Carole Jakucs, MSN, RN, PHN on September 11, 2019

There is a shortage of psychiatrists in the U.S., but some states are in greater need of psychiatrists than others.

One example is the state of Washington, which has only met its need for psychiatrists for its population size, by just more than 11%, according to a recently published report by the Kaiser Family Foundation.

The state needs a minimum of 165 more psychiatrists to remedy its current shortage.

“The shortage has greatly impacted the state of Washington and parallels with the shortage of medical doctors in general,” said Susan Caverly, PhD, ARNP-BC, director of psychiatric services and the integrated cognitive therapies program at Seattle-based Therapeutic Health Services.

Susan Caverly, PhD, ARNP-BC, Director of Psychiatric Services and ICTP (THS)

For 12 years, Caverly also has been involved with the recruitment of psychiatric mental health nurse practitioners (PMHNP). One of the challenges Caverly faces when recruiting the PMHNP role for community mental health is competition with other employers.

“Hospitals often have higher salary structures when compared to community mental health,” she said. “Given the cost of a college education, new NPs come out of school with high loan burdens so choose an employer that pays the highest salary. Also given that PMHNPs and all NPs in Washington have full practice authority, many find it more lucrative to go into private practice.”

Texas is another state with a deficit of psychiatrists.

Jon Stevens, MD, MPH, chief of child and adolescent psychiatry and chief of outpatient services at the Menninger Clinic in Houston, who recruits and hires PMHNPs, said psychiatric NPs are valuable members of the care team in mental health.

“In the last 10 years we’ve seen a rise in the number of psychiatric NPs and they are part of the solution to this shortage,” he said. “However, there is a shortage of PMHNPs too.”

Jon Stevens, MD, MPH

PMHNP shortage decreases mental healthcare access

The impact of the psychiatrist shortage in mental health affects access and creates long wait times for psychiatry, especially in ambulatory settings, said Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP, chief nursing officer, vice president of operations and patient care services at the University of Pittsburgh Medical Center’s Western Psychiatric Hospital in Pennsylvania.

“As an academic center we’re more successful in recruiting and hiring psychiatrists, although it remains a challenge even for us,” she said. “The larger struggle presents with our community settings. As the need for behavioral health services continues to expand, access becomes an issue and the use of NPs can assist with getting needed behavioral health services to people in need of those services.”

Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP,

Herisko said it can be challenging to recruit PMHNPs as there are not enough — only limited numbers graduate each year — and demand is high.

“I’ve heard more psychiatric nurse practitioner programs will be offered soon by colleges and universities,” Herisko said. “I believe that this is a great way to address the shortage.”

Providing working nurses with flexible schedules so they can attend NP school could help increase their numbers, Herisko said.

“I believe more nurses would continue their education in this field if they had a flexible schedule from their current employers to begin such a program,” she said. “At Western Psychiatric Hospital we are very flexible and accommodating with school schedules.”

Strategies to successfully recruit psychiatric NPs

Having a background in psychiatric nursing first, prior to completing a PMHNP program, can help prepare a new grad PMHNP for practice, Stevens said.

“We can’t fill this gap with just anyone,” he said. “When PMHNPs practice to the highest level of their NP license, training and experience, it’s good for patients and an organization.”

Stevens points out when hiring a PMHNP it’s important to have them interview with their co-workers first. If that goes well and the team likes the candidate, the next step of the process is typically an interview with Stevens and other leaders.

“This is important as a new hire may have a good interview with me and other key leaders,” Stevens said. “However, may not click with their colleagues and people they’ll actually be working with on a day-to-day basis.”

Jon Stevens, MD, MPH

Meeting the needs of patients is the goal and one way to achieve this is by using the skills and talents of PMHNPs along with all other mental health staff, including MDs, psychologists and social workers, Stevens said.

“Focusing on what a person can bring to the practice, building on their strengths, and not focusing on their deficits is a good strategy for successful hiring,” he said.

Finding the right person for a job who has a passion for this specialty, can empathize with their patients who are many times in the darkest moments of their lives, as well as building on that person’s talents, can also help with retention, Stevens said.

Herisko said NPs want to start practicing to the full scope of their license upon graduation so look for some independence in practice.

“They want to make clinical decisions and manage patients independently,” Herisko said. “This will require a shift in how programs operate and also the comfort level of having a NP lead the treatment planning.”

Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP,

Additional recruitment perks to provide PMHNPs

Other recruitment strategies Herisko suggested are providing a thorough orientation program, continuing education and financial support for continuing education.

“New hire support and mentoring are very important,” Herisko said. “Transitioning from a nurse to a nurse practitioner can be challenging for new graduates. Additionally, NPs are required to obtain continuing education credits each year and having these paid for by an employer is very enticing to recruits.”

Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP,

Herisko said in addition to offering competitive salaries, offering a comprehensive and competitive benefits package is also important. “Scholarship programs or tuition forgiveness programs are also great ways to support nurses returning to obtain this degree.”

Kristine Highlander, MSN, ARNP, PMHNP-BC, who works for Lakeside Milam Recovery Centers in their residential treatment program in Kirkland, Wash., is president-elect of the Association of Advanced Practice Psychiatric Nurses.

“Offering residencies can be an attractive opportunity for new PMHNPs,” she said.” I’ve seen these offered to new graduates, but if an organization is looking for a seasoned provider, it could be reasonable to also tailor these opportunities to PMHNPs who are transitioning from one specialty to another, such as moving from a private practice focused on pediatric patients, to hospital-based acute care of adults.”

Kristine Highlander, MSN, ARNP, PMHNP-BC,

With the variety of work settings to choose from, including private practice, employers need to set themselves apart, Highlander said.

“Most important is making sure employers are aware of ARNP scope of practice in Washington state, and ensuring that job opportunities utilize this full scope,” Highlander said. “Creating stable work environments, investing in patient care including maintaining multidisciplinary teams, and offering flexible work hours are some additional strategies that may be effective for recruiting psychiatric ARNPs.”

Kristine Highlander, MSN, ARNP, PMHNP-BC,

This Article was Re-Posted from MediaKit.Nurse.Com
Original Author: Carole Jakucs, MSN, RN, PHN – September 11, 2019

Susanna Harris was sitting in her lab class for her graduate program at the University of North Carolina at Chapel Hill when she received an email that told her she had failed what she describes as “the most important exam in grad school,” the doctoral qualifying exam. She took the rest of the day off, went home and baked cookies.

Harris continued with her regular schedule: lab, work, home, repeat. Everything seemed fine until she realized she was having a hard time focusing due to lack of sleep. That’s when she decided to go to campus health to ask for a prescription for a sleeping aid. The doctor said they could give her a prescription, but it would be for antidepressants instead.

Harris was surprised how common depression is among Ph.D. students, so she began sharing aspects of her own mental health journey on social media by creating the Twitter account and hashtag #PhDBalance. People share the stories they might otherwise keep private — stories of anxiety, depression, abuse, substance use, PTSD. Others comment on the posts and reach out to the author. “People have found friends and compatriots through our page based on what they are going through, and I think that is beautiful,” said Harris, who has also shared her experiences onstage at The Monti — a nonprofit organization in North Carolina that invites people to tell personal stories.

While struggles with mental health were traditionally kept private, in recent years a growing number of sufferers are adopting the opposite tack: sharing their mental health battles with the world, via social media.

Celebrities and public figures like actors Dwayne Johnson and Gina Rodriguez and singer Ariana Grande have used social media as a platform to share stories about their mental health and encourage others. Kevin Love of the Cleveland Cavaliers began using his Twitter account to share the story of his struggles after writing an article for The Players’ Tribune — a new media company that provides athletes with a platform to connect directly with fans. The article highlighted how he came to realize that sharing improves not only his life, but the lives of others.

Sammy Nickalls of Lebanon, Pa., is an editor and writer who created the hashtag #TalkingAboutIt in 2015. Nickalls said she did it because, as a University of Michigan study has found, Facebook and other social media can make people feel worse because they tend to show the happier aspects of users’ lives. “When all you see are highlights from people’s lives, social media encourages comparisons, FOMO [fear of missing out], all that good stuff,” Nickalls said. “That’s why I wanted to start #TalkingAboutIt — because if we’re open about the dark times, too, social media will be less likely to make users feel lonely and like their lives don’t measure up.”

People often connect with one another by using hashtags like #TalkingAboutIt and #mentalhealth that have a broad target audience. Others such as #YouGoodMan and #YouOkSis were created specifically for mental health concerns in the African American community. #ThisIsWhatAnxietyFeelsLike is used by people with that specific problem.

People have also used social media to express their increased anxiety about mass shootings. Hashtag #ItsGettingTooHardTo began being used on Twitter in response to the mass shootings that occurred in El Paso, Texas, and Dayton, Ohio. The hashtag #IAmNotDangerous was used to combat erroneous statements that mental illness is responsible for driving people to commit mass shootings.

Lauren Evans, a Philadelphia public relations professional, is a survivor of domestic violence who was diagnosed with post-traumatic stress disorder, depression and anxiety in 2013. The community she found on Twitter, Instagram and Facebook helped her cope. Evans keeps the hashtag #DVsurvivor and words “Mental Health Advocate” in her Instagram bio to help her find other mental health accounts on social media. Finding others who understood her struggle and didn’t discount her feelings was invaluable. She said social media “has been one of the most helpful things for me to have my voice feel validated, especially regarding past trauma. It’s also super cool to network with others who are on their journey, and it makes it seem more socially accepted.”

It is also common for organizations to use social media as a platform to share information, tips and strategies. The National Alliance on Mental Illness has a Facebook page that provides information about events and a safe space for people to discuss their concerns.

Dr. Isaiah Pickens, a clinical psychologist in Los Angeles and founder of IOpening Enterprises, believes that, when used the wrong way, social media can have a negative impact. “Social media can also exacerbate problems if it’s not the right kind of community and if it’s a community that potentially responds in ways that are toxic,” Pickens said. “When people sometimes try to share their experience and their experience is received in a way that increases the type of harassment, intimidation and bullying that happens.”

He cautions that people should think of social media as a secondary tool and get help from professionals and traditional support groups. Seek out groups on social media that share your problem, he said, and give yourself permission to hold back some aspects of your life. It’s important to set boundaries.

For people who are open about their mental health on social media, there is a possibility that they will face backlash from friends, family or co-workers. “One time, when I made an understandable and human — in my opinion, anyway — mistake at work and had also been open about my mental health online the same day,” Nickalls said, “a former employer said something along the lines of ‘Maybe you should focus more on your work and less on your mental health.’”

But overall, she said, “I think people in general are thinking about mental health differently than they did before, and they’re using social media to reach out for community and support.”

If you or someone you know has talked about contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Crisis Chat, both available 24 hours a day, seven days a week.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

THS wants to share this story in order to highlight the use of new technologies in serving an individual’s mental health on a cultural level.

Monday, November 18, 2019
6:00 – 8:30 p.m.

Seattle Center Exhibition Hall – 301 Mercer St, Seattle
Free and Open to All
Registration opens in September.

King County’s 2019 Behavioral Health Legislative forum will include:

• Opportunities for community members to connect with legislators and county councilmembers before the program.
• Remarks by King County Executive Dow Constantine.
• King County’s proposed behavioral health legislative priorities for 2020.
• Compelling personal stories from individuals in behavioral health recovery.
• The perspectives and priorities of legislators and county councilmembers.

For those who can arrive early, a fun and interactive Recovery in Action event will begin at 4:30pm before the forum.

To add the forum to your calendar, click “Add to Calendar” on the forum’s Eventbrite Page.

2018 Legislative Forum Participants by the numbers:

• Around 800 community members
• 17 state legislators & 2 county councilmembers
• 31 total federal/state/county legislative offices represented
• 15 legislators met informally with at least 175 constituents
• 53 community organization co-sponsors
• View the video of the 2018 Legislative Forum Program!

Find out more about King County’s behavioral health 
legislative priorities and state legislative results for 2019.   

Our own Dr. Susan Caverly has once again been named as a “Top Doctor” in the area of Addiction Medicine – Psychiatry by Seattle Met magazine. Congratulations Dr. Caverly on this achievement and the well-deserved recognition for the quality of care you deliver to our patients!

Katrina has a problem. She’s spent the last 10 years coping with a heroin addiction. She’s suffered from her addiction, from her bipolar disorder, and she’s been on and off the street a number of times, dealing with post-traumatic stress disorder. However, her co-occurring substance use and mental health condition and her lack of stable housing are not her problem. Katrina is now sober, stable, and living on her own in a small apartment in Seattle. She’s on methadone to control her addiction and she’s receiving the care and medication needed to manage her disorder. Katrina’s problem is that for the first time in 10 years, she isn’t an addict. Now Katrina has to figure out how to deal with her trauma and turn a new leaf. Luckily, Katrina is not alone. Therapeutic Health Services (THS) is here for her, and with their Trauma-Informed Care model, they can ensure Katrina can turn that new leaf.

Katrina’s story is individual but it isn’t unique. Hundreds of patients are served each day at THS, many of which face the same challenges as Katrina. Each day our counselors are helping patients move past their respective traumas, an effort which is guided by evidence based care that is trauma-informed.

Trauma Informed Care makes safety the chief focus in working with a patient. As Lindsey Arrasmith, CDP puts it:

“Trauma Informed Care is acknowledging that you’ve been through…some stuff. We can begin to separate you from that trauma, from that stuff, in a way that does not bring you down, that does not weigh you down, that does not prevent you from living your life. It empowers you to go achieve your dreams.”

 Lindsey helped lead the effort to adopt Trauma Informed Care (TIC) throughout THS. She was taught about TIC at a previous position where she learned “Seeking Safety” ‑ the modality of care now used by all THS staff. “Seeking Safety” is an evidence-based practice developed by Lisa M. Najavits, PhD at Harvard Medical School and McLean Hospital.  “Seeking Safety” teaches providers to work with clients to develop safety in all parts of their lives; relationships, behavior, emotions, and thinking. The modality can be used anywhere, by anyone, for anyone to help those in need to work through trauma and addiction problems.

Lindsey was deeply moved by her “Seeking Safety” trainings and as she incorporated it into her work, she was touched by how much it helped her serve patients. Working with a patient means going through their trauma with them and providers work hard to ensure this process is safe for their patients.  “I think as clinicians we have this fear, especially in the beginning, of ‘What if I hurt someone?’ Having ‘Seeking Safety’ as a foundation, is a safety net” Lindsey said when asked how the modality works in her practice.

Care isn’t a cure, it’s a process. A person in care has to go through many challenges in treatment. Trauma-Informed Care and “Seeking Safety” helps guide care to ensure patients can recover and move toward leading better lives. Therapeutic Health Services trauma-informed care policy recognizes that “survivors need to be respected, informed, connected and hopeful regarding their own recovery.” Under the guidance of this new policy, all staff at THS are working together to create safe environments where patients are empowered to reach their own goals and make full recoveries.

We want to share Royale’s story with you. Royale was a client of our Youth and Families program. His story, in turning his life around, is a bright light that we hope brings you a smile. We serve many young people like Royale and we hope to share more stories like his with you in the coming year. Please consider making a gift today to ensure we can continue lighting up lives like Royale’s.

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed, as well as your rights regarding this information and how you can get access to this information. Please review it carefully.

Effective Date: Jan 1, 2018

Your Rights

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds

Our Uses and Disclosures

We may use and share your information as we:

• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?
We typically use or share your health information in the following ways:

To Treat you

We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.

To Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.

To Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

Help with public health and safety issues

We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see here: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available upon request, in our office, and on our web site.

Veggie Tails and Honesty

When my daughter was younger, she’d love to watch Veggie Tales. I had a copy of one of her favorite VT videos. The title: Larry-Boy and the Fib from Outer space. The premise of the storyline focused on dishonesty vs. honesty. Each time Jr. Asparagus told a lie, the character Fib grew larger and larger. At the end, Fib became quite big and caused trouble for Jr. Asparagus. It was only when Jr. Asparagus realized he needed to tell the truth. Each time he spoke the truth, Fib decreased in size. A simple message for children. Yet, a fundamental principle truth for people in recovery.

In Sobriety Demystified: Getting Clean and Sober with NLP and CBT, author Byron A. Lewis, M.A. writes:

“…This clearly demonstrates a primary curative aspect of the Twelve steps program: the focus is not on the problem, but rather on the solution. …intrinsic to this step is a primary principle of Twelve Step programs known as rigorous honesty.”

What Lewis is referring to is the hard-line truth: all individuals suffering from substance use disorder come to a place of admitting to the fullest extent the nature of their problems. In line with the First Step, Lewis remarks how it is the start of the process.

Admission of Powerlessness

A person becomes powerless because substance use becomes a pervasive, chronic, and progressive disease of brain reward and motivation. Lewis comments on how ongoing sufferers of substance use tend to foster a tendency toward ignoring the consequences of compulsory behavior. Instead, the individual believes they are capable of handling problems associated with their continued use.

While they may trust in their own confidence in managing problems, despite continued use, there is repeated failure in moderating, limiting, or controlling their actual use. Instead, problems become exacerbated. Continued use despite negative consequences.

As a moderately seasoned counselor, I provide the following information to my patients:

• Inability to manage when substances are consumed
• Inability to manage the amount of substance use being consumed
• Inability to manage behaviors associated with being impaired/under the influence
• Inability to manage any withdrawal symptoms being experienced because of increased substance use

In Alcoholics Anonymous, one may even hear someone say, “I just can’t stop at just one drink”. They are admitting the reality of their own inability to control how much, how often, and how they behave once they start drinking.

It is this moment of clarity and honesty with themselves, a person may be able to start laying the foundation for a recovery-based program.

The Power of Honesty and an Unmanageable life

Not only has an individual become powerless over their substance use, but their lives have also become unmanageable. This recognition is a second layer of the foundation. Another rigorous honest approach is the acknowledgement of the pervasive impact it has had on the individual sufferer.

“For the addict in the midst of addiction, life is often a downward spiral that ends in incarceration, institutionalization, violence, loss, and death. Some may continue to function in seemingly normal ways – working, parenting, and participating in society – but an internal death occurs, a numbness arises, and they start to disconnect from themselves and from others. A wall of denial and suppression, too high and too thick to scale or break through, keeps others out and keeps the addicts in, trapped by [their] own defenses, prisoner to [their] own addiction (Refuge Recovery – Addiction Creates Suffering, pp 3-4).”

Noah Levine

Levine continues with these points on how suffering manifests in an individual:

1. Stress created by craving for more
2. Never having enough to feel satisfied
3. Stealing to support continued substance use
4. Lying to hide ongoing substance use
5. Ashamed and Guilty of one’s behaviors
6. Feeling (belief) of unworthiness
7. Living in constant fear the consequences of one’s actions
8. Intense emotions of anger and resentment
9. Hurting other people and self
10. Intense hatred toward self and others
11. Jealousy and envious of others
12. Feeling victimized and/or inferior toward others
13. Selfish due to being needy and greedy
14. Lack of confidence toward genuine sense of happiness and wellness
15. Anguish and misery of being enslaved by continues substance use

The nature of unnecessary suffering (as Levine remarks in his book) is a battle between our desires for happiness versus our need for survival. In ongoing substance use, it is merely about survival from one moment to the next. A person’s life is focused on seeking out, obtaining, using, and recovering from the effects of alcohol and/or drugs.

Levine makes this statement on how one’s recovery is fundamentally founded on the principle of honesty:

This is a process that cannot be skipped or half-assed. The foundation of our recovery is a complete admission and acceptance of the suffering that we have caused and experienced due to addiction.

Noah Levine

Levine continues by explaining that this rigorous honesty needs to happen in order to do away with any shred of denial, minimization, justification, or rationalization. It is a principle truth that requires a radical honest approach toward healing. This radical honest approach encompasses two truths:

• Come a complete and total understanding of the reality of our own suffering and negative impact substance use has had on our lives.
• Accept the reality and truth that it is because of our continued substance use that is the causation for our own suffering.

Through our admission and acknowledgement, and by embracing the reality, that because of ongoing substance use, one has become powerless and life had become unmanageable.

Moving Toward Freedom

Admission to our sense of powerlessness and inability to manage life is the first step in creating an abstinence-based recovery program. An individual begins to experience freedom by striving toward physical sobriety. Once physical sobriety is achieved, an individual starts the hard work of reaching emotional sobriety.

Physical sobriety is the ability to establish and sustain life without alcohol and/or drugs. It is the ability to manage and cope with the symptoms of withdrawals. Keeping up daily empowerment to use different ways of managing cravings instead of those that lead back toward substance use. It is the ability to regain self-control and making daily decisions not to drink or use.

Emotional sobriety is more rigorous in bringing an individual face-to-face with their own inner turmoil. Learning how to manage intense emotions. Becoming empowered to move toward healthier relationships, financial stability, regain a peace of mind, finding meaning and purpose, rediscover core values and beliefs, and practicing a healthy lifestyle. It is a process of transformation and restoration of our true sense of identity.

Through emotional sobriety, a person regains the ability to manage their own emotions. This does not mean we fake it till we make it, or, force ourselves to think positively all the time. It means we are honest with ourselves when it comes to the nature of our own emotions: Positive or Negative. If we are not managing our emotions, our emotions are managing us and we end up not doing well. We fall short because we return back to our old behaviors.

The Nature and Power of Honesty

Like Jr. Asparagus, a person suffering from substance use creates a life that is dishonest. It becomes a rather large beast in their life. The only way we are able to bring ourselves back to the right way of living is by a radical and rigorous honest approach. The more we are honest with ourselves, the smaller and insignificant our own suffering becomes.

While it does not free ourselves from the consequences of our substance use, it does empower us to face those consequences in order to regain mastery over our own lives.

If you are struggling with substance use, Therapeutic Health Services offers a variety of treatment options for you. We offer regular intensive outpatient, outpatient, relapse prevention, MAT-Methadone, and MAT-Suboxone. Please see below to connect to care.