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December 1, 2007
by root
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Article shines light on field's stigma

In the October issue, Drs. Lori Ashcraft and William A. Anthony note that one in four behavioral healthcare staff members likely has a mental illness (the same rate as the general population), a fact that the field often does not acknowledge. This statistic came as no surprise to me.

After struggling for years as an adult behavioral health clinician with attention deficit disorder and the subsequent depressive episodes related to it, I finally “came out” about it to my supervisor in a behavioral health setting. I requested a few minor accommodations in our open-space work environment, such as privacy panels around my desk to cut down on distractions while working on paperwork. Rather than supporting me, she openly expressed disbelief, discounted a psychiatrist's report/diagnosis, and took her opinions to management levels. The atmosphere became so uncomfortable for me that I ended up leaving the behavioral health field altogether. I was afraid my diagnosis would follow me into a new position and I would get the same negative reaction.

I no longer work directly in the behavioral health field, but I remain guarded about my diagnosis. I make “covert accommodations” so that my deficiencies aren't readily detectable. I feel that my personal experiences enhance my clinical skills. However, I cannot risk working in the mental health field again because of the trauma I experienced. It is a very sad commentary on behavioral health professionals. Thank you for highlighting the problem.

Rebecca Cichetti, MA, NCC, Licensed Professional Counselor

Keep in mind quality-of-life issues

After reading Philip L. Herschman's response (October issue, page 8) to Doug Tieman's article “In support of abstinence” (July issue, page 45), I couldn't help but respond. I have been actively involved in the addiction treatment field since 1980 and support an abstinence approach to addiction treatment.

Any way that you slice or dice it, methadone maintenance is considered part of the harm reduction model. The main goal is not abstinence but rather substitution of a legal narcotic for an illegal one to reduce the negative consequences of addiction on our society. This still leaves the client/patient dependent on a highly addictive narcotic in order to function on a daily basis. One of the main goals for methadone maintenance programs is the reduction of harm caused to our society (by lowering crime rates and decreasing health risks).

Mr. Herschman states that “methadone maintenance treatment (MMT) is the most effective treatment for opiate addiction” and cites research from the National Institutes of Health. However, I question whether such research compares MMT to true abstinence-based treatment. My experience with methadone maintenance programs indicates that only about 2 to 4% of clients are ever successfully detoxed from methadone.

In my opinion, any discussion of treatment effectiveness must include quality-of-life issues. How should we define quality of life? Is a higher quality of life obtained by becoming free from addictive drugs or by being maintained on a highly addictive substance? That's a question that one answer won't fit every case. However, my experience with abstinence-based programs and my observation of MMT lead me to conclude that abstinence-based programs offer a much higher quality of life.

Finally, Mr. Herschman's letter equates the need for medication to treat chronic diseases, such as diabetes and asthma, to the need for medication to treat addiction. Unlike diabetes and asthma, successful addiction treatment does not depend on a medication. My observations over the past 27 years support my belief that most people can successfully recover from this illness without the need for mood-changing medications.

I recognize that in treating this disease “one size does not fit all.” There is a place for methadone maintenance programs just as there is a place for abstinence programs. If the goal is to free the addict from the chains of addiction, then the abstinence model is the most effective (and maybe the only) option. If the goal is to try to reduce the harm that the addiction is causing, then a maintenance program may be the right choice.

Jimmy Mooney, Chief Executive Officer, Willingway Hospital, Statesboro, Georgia