mortiz095

Among the various things I do, I work about half time for a large health care organization (HCO) in Minnesota called Allina Health. Currently Allina is the largest HCO in Minnesota, but it is likely to become the second largest due to continuing consolidation in HCOs. HealthPartners and Park Nicollet, two other HCOs in Minnesota desire to merge, and it does not appear that there will be any barriers from either the MN Attorney General or federal agencies. So it is likely to proceed, which would produce a larger HCO than Allina. Consolidation in health care is almost a torrent right now. It's happening very rapidly. In the Twin Cities area in Minnesota, there are almost no independent primary care practices; they've all been purchased by large HCOs. The health plans like Blue Cross/Blue Shield and HealthPartners are working very closely with the large HCOs to create products that maximize value to the consumer. So the future of health care is one dominated by a few large HCOs th...

Recently I have several patients who have made remarkable progress in a short time. I would call this discontinuous change.  That is, there is a prevalent notion that change occurs gradually, step by step. And sometimes that's how it happens. But then there are times when people change in multiple ways, on multiple dimensions, all at once. Change can be continuous or discontinuous. Now, in some ways this distinction requires some kind of arbitrary decision about what those terms mean. Ultimately, it's an issue of measurement. So, "continuous change" occurs at a smaller scale than the current measurement can detect, while "discontinuous change" occurs in a way that is distinct, a detectable change. Or, one could define it quantitatively or qualitatively. For example, "discontinuous change" could be defined as a change of a certain magnitude, or changes of a certain magnitude on multiple levels or in multiple scales. But clinically, there are times w...

Recently, I've become more aware of search engine optimization. These are strategies to increase the likelihood your site or blog will come up sooner rather than later in a search on a given term. For example, "addiction." Although I am personally attached to the name Substance Matters, it doesn't necessarily come to mind (or search engine) when someone enters a search term related to the use of intoxicants and substance use disorders. So it needs a new name, and I need your help. So... I'm open to suggestions for a new name that will maximize visibility on the web. It may end up having to be boring, for example, it may have to have addiction in the title. But, let's see what we can come up with. Thanks to my followers and contributors, and thanks for helping me out with a new name. So please send your suggestions, and then I'll give you all a chance to vote on the best 3 names submitted. How about that? Hmmmm..... Intoxiblog? Addiction and More? Addiction...

This morning, Francis Collins, MD , PhD, the Director of the National Institutes of Health announced that he had decided to reverse his earlier decision to proceed with the merger of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) . This is a cause for celebration, as the merger was a solution in search of a problem right from the start. For most of us at NIAAA (this process started when I was still there) it always looked like a simple power grab by NIDA and a relatively small but influential group of researchers and policymakers closely affiliated with it. The White House Office of Drug Control Policy  (ONDCP; the Drug Czar), former NIDA Director Alan Leschner (who coveted NIAAA when he was at NIDA,) and current NIDA Director Nora Volkow  all pushed very hard to make this happen. The "problem" it was supposed to solve were "missed opportunities" to pursue research involving both alcohol and drug di...

Here's a blog from a guest blogger, Ian McLoone, who is  a student in the Integrated Behavioral Health Master's program at the University of Minnesota, as well as a Graduate Research Assistant at the new MN Center for Mental Health, which is focused on treatment for people with co-occurring mental and addictive disorders. Welcome Ian! MW P.S. Anyone else want to volunteer? I'm open to blog submissions. Why the Election Results Are Good News for Addicts and the People Who Treat Them As Tuesday’s election results trickled in, addiction and mental health professionals throughout the country breathed a collective sigh of relief. President Obama’s re-election means that the Affordable Care Act - affectionately termed, “Obamacare” – is safe from the Romney/Ryan campaign promise of “total repeal” of the law (1). This means that President Obama will have the opportunity to oversee the implementation of his signature first-term accomplishment. What’s more, addiction res...

A number of my recent postings have focused on chronicity, treatment-resistant disease, and staying connected with people who are not doing well no matter what. These are important principles to me and to others who are dedicated to helping people with addictions overcome them if possible, but to continue to work with them if it is not. It is so important to talk about this, to advocate for this, because too often people who have addictions unresponsive to current treatment are condemned, abandoned by their families and friends in the guise of "tough love," prosecuted for crimes and imprisoned, unemployed and homeless because background checks reveal a criminal history. They deserve our care and compassion in spite of, indeed because of, their plight. This service is informed by our humility in the face of a difficult, complicated problem that too often defies effort, faith and science. However, I witness a lot of successful outcomes, and I need to share those too. As an addi...

Anne Fletcher, author of  Sober for Good, Thin for Life , and other books about how people overcome destructive health behaviors, recently commented on my blog about Hazelden's historic shift to (finally, and belatedly) embrace Suboxone maintenance for opioid addiction.  She wanted me to add that she hopes those with a public voice who've spoken out against maintenance treatment, including Dr. Drew Pinsky and Russell Brand, will come along, too.   (They seem  to  subscribe to   ideology or opinion or hot air, not science). Please visit her website at  http://annemfletcher.com/  for more info. Her newest book chronicles the stories of people who have been through rehab, 12-Step and others. It is a great read! (Full disclosure: I served as an informal and unpaid consultant on the book, offering opinions about various evidence-based topics. But I don't have any financial connection to Anne or the book.) This book offers an unparalleled view...

Many of you may already have heard that Hazelden is starting a pilot project involving Suboxone maintenance treatment . This landmark shift is primarily due to the skill and persistent effort of Marv Seppala, MD, Hazelden's Chief Medical Officer. Marv and I go way back. I was on the faculty in the Department of Psychiatry at the University of Minnesota when Marv was a resident and then, subsequently, an addiction psychiatry fellow. He and I have stayed in touch ever since, and he and I and Carol Falkowski, another member of the old guard in Minnesota get together for lunch every few months. Marv is a great guy in addition to being a top-notch physician and psychiatrist. He is one of the few people who could make something like this happen. He is widely respected in the 12-Step and addiction treatment worlds, yet he is also a true professional who reads the research and believes in science. When he returned here to Minnesota from Oregon (where his true home still is) to work at Ha...

It's interesting that in response to my talking or writing about research on addiction treatment, I'll get anecdotes in return: "I don't care what the studies show, I got sober without medication!" So we've got to get the stories of people who have benefited from modern treatment methods out there too. I reader wrote an email to me recently, and gave me permission to publish it with identifying info deleted. If you don't believe in research, or believe me, perhaps you'll believe what the people directly affected have to say. Here's the email, and thanks again to the reader who allowed me to publish it. . Hi Dr: I have been reading some articles on you as my interest in Suboxone has come about because my 31 year old heroin addict son is trying it.  He has been in detox 4 times, holdings 3 times, 8 months of sobriety in the last year and currently got kicked out of a holding after waiting two months for a halfway house (for smoking). He is now with h...