Nenana Wellness Coalition
January 28, 2014
The Nenana Wellness Coalition is an alliance of representatives from various organizations, government agencies, community groups and individuals that meets weekly to discuss, evaluate, coordinate, consolidate, masticate, celebrate, and help implement plans for improving the wellness and quality of life in Nenana Alaska.
There were 16 in attendance today, including: Kat McElroy, David Poppe , Bill Troxel, Penny Forness, Amie Verhagen, Bonnie Reed, Evelyn and Johnny Verhagen Steve, Nick and Damitra DuPlantis, Gloria John, Chuck Hugney and Nicki Bird. We enjoyed baked meatballs with pasta and mixed vegetables, fresh garden salad, Ritz crackers with sliced cheese and raisins and pecans for lunch.
WELCOME followed by the READING OF MISSION STATEMENT, by this week’s chair-person: Bonnie Reed.
PRAYER was led Bill Troxel, followed by the PLEDGE OF ALLEGIANCE
PRESENTATION OF AGENDA AND CALL FOR MODIFICATIONS: There were no changes to the agenda as presented today.
APPROVAL OF MINUTES: Minutes were posted at the WIN link at http://www.railbelt.org and submitted electronically to the WIN e-list.
INTRODUCTION OF GUESTS: One new guest today; Gloria John was welcomed as this is her first time attending WIN.
I Care, But What The Heck Should I Do?: Kat began her remarks by telling a little bit about her own personal history, as the child of an alcoholic, who later developed alcoholism herself, and some of the struggles she experienced coming to understand what addiction is and strategies that can help. She said that she got sober in Alaska in the mid-80’s, at a time right after the construction of the pipeline, when Alaska had a lot of money and were spending huge sums educating people and communities about addiction and recovery. Because of the high rates of addiction and the consequential costs to society, the state had determined to make what is called “Treatment Upon Demand” available to anyone requesting treatment services, and much effort had gone into educating police, magistrates, medical and social service providers and even educators to recognize chemical dependency and help make people experiencing addiction aware of the resources available to help.
Unfortunately, today, there are fewer treatment slots available all the time, funding for treatment services is continually being cut, and maladaptive alcohol and drug use increasingly criminalized. The social climate, she explained, has changed dramatically. Kat provided handouts to illustrate her next points. The first one was a diagram that spoke to the dynamics that lead to addiction. About one in ten people who use psychoactive substances will develop addiction. The set-up begins with experimental use. Psychoactive substances are attractive to people because they affect the ways we think and feel. Kat used a feelings continuum to illustrate the set-up for chemical dependency. People usually just feel “okay” (neither too happy, nor too sad, somewhere in the middle of the feelings continuum). Drugs (like alcohol, cocaine, marijuana, opiates or stimulants) alter those feelings, creating a sense of euphoria. We are rapidly pushed into a sense of high euphoria, due to the effect of the drug on our brain chemistry. When we come down off the drug, we return to a middle sense of just being okay. If we feel unhappy or distressed, due to mental health issues like depression or other psycho/social factors such as trauma, chemical use will create a sense of euphoria, but with repeated use, each time, we slip further back on the feelings continuum, towards a sense of distress, or dysphoria. Slowly over time, or more quickly for some people, each drinking or using episodes brings less relief and increasing distress. At some point, the chemically dependent person finds themselves using drugs or alcohol just to feel okay or normal, and ultimately not being able to achieve even that. There is a loss of control of use, which creates a sense of shame, and results in people hiding their use, lying (to themselves as well as to others) not only about what and how much they are using but also about the negative consequences they are experiencing. This has been called denial, but in reality it is delusion. The chemical dependent person may not actually be aware of how serious, in fact, the problem has become.
This increasing sense of distress actually creates opportunities for people to re-evaluate their relationship to chemical use. How can you help:
Describe what you see. Avoid feelings statements, stick to the facts.
Avoid blame or shame. The person experiencing addiction is filled with shame and they are very practiced at avoiding shame and at casting shame. Neither is helpful.
Provide resources and information. Resources can be as simple as soup or other nutritionally dense easily digested food stuffs. Do not provide cash money, but if you feel compelled, pay bills. People active in addiction may mean well but often cannot be trusted to be responsible about money. Information can be vital; where is detox and how do you get in?
Offer assistance and/or physical and emotional support.. Giving rides, holding hands, staying up late to listen can be the most important thing you might offer. Sometimes the only meaningful thing you can do is be there to bear witness and affirm another’s process.
Be prepared for relapse. Addiction is a chronic relapsing disorder. There will be set-backs. Do not expect immediate success. But look for slow, uneven progress.
Kat’s next diagram depicted the chain of events for people to receive clinical services. The first box illustrated initial steps: Identification of the problem (it’s addiction, a mental disorder, a brain chemistry imbalance, it is not a moral issue); Consultation with a treatment provider (which is free at Railbelt); Intake (which is a huge packet of paperwork that has to be filled out, usually takes an hour or so); then an Assessment, (which is a lengthy interview that hopefully will result in a diagnosis. Without a diagnosis, one cannot receive substance use disorder treatment services!). Of all the paperwork, the most important is a release of information. Treatment providers are restricted by federal regulation 42 CFR which is much narrower than HIPAA in regards to information exchange. Without a release of information in place, a provider cannot speak specifics to anyone, not to family members, nor concerned friends, nor other professionals. To be legal, a release needs to have the name and birth date of the clients, their signature, a witness’s signature, the date, the timeframe in which the release is valid, the exact nature of the information being released, to whom the info is being released and the specific reason. The purpose of the release is to help the client feel safe, to avoid stigma, to protect privacy. The problem is that it also ties a provider’s hands in regards to bringing significant others into an intervention or a treatment episode. Bottom line, anyone can provide us with information: we can listen. We cannot provide anyone with any information without a valid release in place first. It can be cumbersome.
Once there is a diagnosis, we case staff the assessment to determine an appropriate level of care, then either provide the care or provide a referral to the agency that can provide that level of care. We can also provide interim services, as most likely anyone seeking residential treatment services today in Alaska is going to go on a wait-list that could be as long as three months or even 18 months, depending on the level of care needed. People who have good health insurance may be able to get immediate residential services outside of Alaska, in which case we can provide assistance in obtaining applications there.
Immediately upon entering into any level of substance use disorder treatment, one should begin discussing continuing care. Treatment helps to separate the person experiencing addiction from their drug(s) of choice, helps to educate about the dynamics of addiction and relapse prevention, but at some point it becomes all about community-based recovery support services. Kat’s last diagram divided recovery needs into four quadrants. One quadrant is about family, friends and the neighborhood. One must have a safe place to live and a sense of connectedness. If their family or neighborhoods are not safe, they need to figure out how to deal with that. Another quadrant is about work, education, hobbies, and recreation, all of which contribute to a person’s sense of meaning and purpose in life. The third quadrant is about health-care and ongoing clinical services. Sometimes addicts in recovery end up having to educate their health care providers about addiction and recovery. It is important that they be aware of special medical needs and prohibitions for recovery. Alcohol based medicines, for instance, and many pain relievers, can trigger relapse. The final quadrant was about spiritual growth. Some people use church. Some take to 12 step recovery process like AA, Na, or Alanon, Reformer’s Anonymous or Celebrate Recovery. Some throw themselves into volunteer work or other service projects. It seems to be helpful.
Kat closed her remarks by describing some of the things that make Nenana ideal for community-based recovery support. We have a small population; people all know one another. We are close-knit; people care about one another. There is a spirit of volunteerism; people believe we are here to help one another. Marilyn Dugger was unable to be here today, Kat said, but wanted people to know that she is always willing, any time, to go sit with people, to pray, or just to listen. That is an example of how our community reaches out. Our local sober house, she said, is another example of this. It has been in existence for about five years and there have been six people who have utilized it. We have about a 50% success rate if ongoing sobriety is the determinant factor. We have a 100% success rate if people feeling safe and knowing there is help is the criteria used to measure success. If people are unable to stay clean and sober, they are asked to leave, no blame, no shame, and will be welcomed back if they feel ready to try again. It is a small investment that continues to reap huge rewards.
Discussion ensued. We talked about the shift over the years in EMS response to alcohol and drug-related incidents. The Duplantis family mentioned a church=based recovery program that they could make available. Penny asked if it would be possible to put together a list of people willing to assist. Chuck Hugney described an outreach program his church in Fairbanks has created, providing needed personal use items, hand-warmers, neck-warmers, granola bars, etc., as a means of reaching out and establishing connections with indigent people. He also said he would like to see us create a cohort of people who would be willing to take in youth expelled from NSLC, to serve as temporary foster placement so these students educational process would not have to be interrupted due to a bad choice. He and Carrie have done this several times, successfully. Kat said she would be willing to go with him to talk to the school board about this. She and David have had a couple of NSLC kids bounce into their homes over the years, also. It is an issue that can be addressed locally with our own resources. Penny mentioned the Natural Helpers program in which her children participated. She would like to return to that as it seemed an effective strategy to help teach youth to deal with their issues. Evelyn Verhagen said that their church Missionary Elder couples who would be willing to make themselves available several times a week to help in community based recovery efforts.
WELLNESS THOUGHT: The Red Road is the path we walk on when we want a direct relationship with the Great Spirit. This requires sacrifice. This requires us to have our beliefs tested. To walk this path is really man honor. The returns for doing so are exciting, not only for ourselves but for the effect that will be felt for three generations. This means your children will see the benefits as well as your grandchildren. Do I want to walk this sacred road?
We didn’t have time for announcements today.
ADJOURNMENT: 2:10 PM