Posts Tagged substance abuse
Just a quick update.
Dr. Robert Mines (chairman and psychologist) and Dr. Dani Kimlinger (CEO) from the MINES Team were honored to contribute to an article by Bruce Shutan in this month’s issue of The Self-Insurer. The article is called Beyond Opioids and covers how EAPs, like MINES, and good benefit-plan design can help treat addictions and other substance use issues in an employee population as well as control overall health care spending.
The issue can be viewed here:
Check out other Self-Insurer publications here: https://goo.gl/2TjaUV
And check out other MINES publications here: www.minesandassociates.com/about_staff_publications.html
To your wellbeing,
The MINES Team
Psychology of Performance – 42: Integration of Behavioral Health and Medicine in Self-Insured Organizations
There are many conditions, both acute and chronic, which have significant psychological components to them. It is well-documented that medical costs for diabetes, asthma, cardiac events, and others are significantly higher when there is a co-morbid diagnosis of depression, post traumatic stress, or substance use disorder. As a function of this relationship and the impact of the Affordable Care Act (ACA), there is a need for integrating behavioral health services.
The integration needs to occur at the strategic/systems and tactical levels. On the tactical side, there are already case studies in the public healthcare sectors and in Kaiser Permanente of placing mental health professionals in medical clinics and offices so the doctors and nurses can just walk a patient down the hall to see them once a psychological component has been identified. At MINES we are piloting a wellness coaching model for individuals who are identified by their healthcare provider as a pre-substance use disorder patient, through a Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant awarded to Peer Assistance Services.
At the strategic/systems level, integration has significant utility and challenges for self-insured organizations whether as an individual entity or a multi-employer trust. At this level, a key component is the ability for the various vendors to cross-communicate on these types of patients. This involves the ability to do data mining to identify the patients, having an intensive case management behavioral health specialist to be the point person, regular communication between the TPA, pharmaceutical vendor, medical utilization review, behavioral health utilization review and the medical/psychological personnel responsible for treatment. An obvious challenge is getting buy-in from all of these stakeholders. There is no incentive other than good patient care for any of these groups to cooperate with each other. To rectify this, incentives would need to be financial or contractual. Employers have leverage on the contractual side as it is their health benefit and their money. At the time of this blog, there are case-studies of organizations moving this direction; however, specifics are a long way from full integration due to the complexities required.
I would welcome your discussion and wisdom on this issue.
Have a day filled with extending loving kindness to all those you encounter,
Robert A. Mines, Ph.D., CEO
It may be self-evident to many of you reading this blog that alcohol use, sleep deprivation, and obesity can negatively affect performance at work or at home. If this is a correct assumption and you have all three of these areas under control, thank you. On the other hand, after 39 years of working with people and organizations on these issues it is clear to me that our society continues to miss the boat on them.
This week alone, I had client organizations call about each of these concerns. In one case a senior executive was observed to drink one bottle of wine at a company function, plus cocktails before dinner. Her behavior became problematic when she propositioned a male colleague, angrily denied she had drank too much and proceeded to accuse others on her executive team of “being out to get her.” To make this situation even sadder, the executive had done something similar three years earlier at the same company function. This became a performance issue at a number of levels. First, upon investigation, it turned out she had a number of days in the last few months where her secretary reported she left early for lunch and never returned resulting in significant loss of individual productivity. Second, she created liability for her company when she propositioned a colleague. This created a potentially hostile work environment/sexual harassment lawsuit. In addition, there was lost time for human resources, management, and legal to review the situation and interview all parties. Third, when confronted with her behavior and the company’s requirement to go to the employee assistance program for an evaluation and potential referral for treatment if indicated, she refused and resigned. This resulted in additional loss of intellectual capital and the personal long term health costs to her. This reminder for everyone in supervisor, management, or executive functions is that alcohol and other substance use disorders have not diminished despite policies, procedures,’ and education interventions. It is important to stay alert to your employees’ and colleagues’ behavior and act in a timely and compassionate manner similar to the company discussed in this paragraph.
The research on sleep deprivation is well documented. Sleep deprived individuals do not function well cognitively and their reaction times are diminished. This finding was significant enough for one researcher to say that sleep deprived drivers were more dangerous than alcohol impaired drivers. What are the costs to your organization related to sleep deprivation? We know that individuals who are sleep deprived eat more, make poorer food and exercise decisions, are more irritable with others, and make poor decisions. Many companies recognize the dangers of sleep deprivation and provide nap rooms, meditation classes, and other options so that employees can refresh themselves and perform better at work.
Obesity, wellness, and financial impact discussions are ubiquitous on the internet and in the professional literature. Our workforces are getting fatter and fatter. Recent research suggested that obesity not only has downstream health costs for the employer, there is some evidence that cognitive functions can be influenced as well. This research needs to be replicated. Then there is the subgroup of morbidly obese individuals who also have co-morbid depression. Depression affects performance in terms of diminished problem solving skills, concentration problems, social withdrawal, lowered energy which is compounded by the lower energy associated with morbid obesity, as well as other symptoms such as memory impairment. Any of these symptoms will negatively affect performance in most jobs. As an employer it will become an even heavier burden going forward to manage the workforce as the obesity incidence continues to grow. What is becoming more apparent is that the typical wellness program is unsuccessful in helping the morbidly obese. A major component that is missing is the psychological aspects of performance related to weight loss and weight gain. The research in this area has been well established for over 25 years. Coors Brewing in 1988 was one of the first companies to incorporate an intensive outpatient obesity program as part of its wellness program. It was a highly successful program. Unfortunately during that time there were many fasting programs and one of the unintended side effects of these programs was an increase in gall bladder surgeries and the corresponding cost. Due to a variety of factors beyond the scope of this blog, all weight loss programs were discontinued a few years later. There are best practice examples of successful interventions with the morbidly obese employee population which apply the psychological elements needed to lose and sustain weight loss.
Contact us if you would like to learn more:
Have a day filled with loving kindness and compassion,
Robert A. Mines, Ph.D., CEO & Psychologist
I recently attended an annual dinner/forum for a local non-profit group which focused on Drug Abuse Prevention. We’ve all heard, or experienced first-hand, the devastating effects of drug abuse on family, employment, education, and just about every other facet of human life. What we don’t always hear about are the amazing efforts by some making an incredible impact on prevention. By taking small steps to identify risk factors, especially for our youth, we can have a tremendous impact. At the forum, one of the panelists made a great point about how parents and doctors don’t ask the difficult questions, and often times because they are afraid of the answer, or maybe they are suffering themselves. Why do our doctors have no problem asking us about our diets and suggesting cholesterol screenings, but very seldom ask us a simple question like, “How are you feeling emotionally?” or, “Does your child seem to be fitting in, and participating in a healthy way?” When we look at diabetes and heart disease compared to major depression or substance abuse disorders only a small fraction of those suffering from behavioral disorders are actually being diagnosed and treated compared with their medical counterparts.
As the prescription drug epidemic continues to rise we need to do more in the area of prevention. Here are some wonderful resources for prescription drug abuse prevention from our friends at Peer Assistance Services:
Manager, Business Development
In over 35 years of working with people on making change, improving their performance, and living more fully it is still interesting to me how many people persist in doing the same self-defeating actions over and over despite saying they want to improve, grow, or change for the better (whatever that means). So the following are four questions worth asking yourself if you want to improve your performance in some area of your life.
- Situation Questions – Tell me about your life? How is it working now?
- Problem Questions – Can we be specific about what is not working? Are you concerned about your current quality of performance?
- Implication Questions – What happens if you don’t do something different?
- Need-Payoff Questions – If you act and it improves – how does that impact your life?
Take time to reflect on these questions, write down your answers, and be curious about where this may take you. If you find yourself resisting the questions or process, look more deeply into that instead.
It’s up to you….as they say “no one can do your push-ups for you.”
Exchange love and happiness with everyone you meet today.
Robert A. Mines, Ph.D.
CEO & Psychologist
The book, Spark, by John J. Ratey, M.D. is the holy grail of research applications related to the interaction of exercise, neuroplasticity, and performance. The information on brain chemistry changes in the areas of learning, addictions, anxiety, depression, women’s issues, ADHD, and aging is priceless. The essence of the book is that the data indicated the brain is able to create new neuronal connections, grow new nerve cells throughout life, manage major psychological conditions, pain conditions, and learning is significantly enhanced through exercise. Ratey stated that “exercise is the single most powerful tool you have to optimize your brain function”- based on hundreds of research studies (p.245). Ratey suggested that the more fit you get (regardless of where you start), the “ more resilient your brain becomes and the better it functions both cognitively and psychologically. If you get your body in shape, your mind will follow” (p. 247).
How much is enough? Ratey stated that walking is enough. Low-intensity exercise is at 55 to 65% of maximum heart rate, moderate is 65-75% and high intensity is 75-90%. “The process of getting fit is all about building up your aerobic base” (p.251). Ratey goes on to discuss the role of strength training and flexibility as important elements of optimizing your brain chemistry and hormone levels.
What does this have to do with optimizing your performance at work and in all areas of your life? Everything! Get started today and stick with it.
Have a day filled with optimal brain chemistry,
Robert A. Mines, Ph.D.
CEO & Psychologist
I ran across some interesting information on the role of niacin, depression, and alcoholism in performance at www.doctoryourself.com. It is well documented that depression and/or alcoholism may negatively affect performance across just about any domain one can perform in. In the treatment of depression and alcoholism there are very effective cognitive-behavioral psychotherapy interventions. In addition, exercise and medication may add additional therapeutic effects. The role of nutrition may have further potentiating influence.
According to this site, Bill W., the founder of AA, was successfully treated for depression with 3,000 mg of niacin a day. Unfortunately, this information has not been widely discussed or published in the media. I would be interested to hear from any of you who have used niacin as a means of treating depression or alcoholism and what your results were. Please let us at MINES know.
Have a day filled with mindfulness,
Robert A. Mines, Ph.D.
CEO & Psychologist
Overcoming any addiction is often a life-long journey filled with as many peaks as there are valleys. Getting support from your family, friends, and treatment providers is an important part of maintaining sobriety. If you are looking for additional support check out these free resources at http://store.samhsa.gov/home . As always, we’re here to help.
~The HealthPsych Team