the impact of disaster o n recovery...the impact of disaster on recovery: the perfect storm 4/3/2020...

The Impact of Disaster on Recovery: The Perfect Storm

4/3/2020

Presented by Timothy Legg, PhD, PsyD, PMHNP‐BC, MAC 1

T H E I M P A C T O F D I S A S T E R O N R E C O V E R Y

T h e P e r f e c t S t o r m

Welcome, your facilitator will be: Samson Teklemariam, LPC, CPTM

• Director of Training and Professional Development for NAADAC

• NAADAC, the Association for Addiction Professionals

• www.naadac.org

• [email protected]

Technology assisted addiction recovery. Built on research, made with compassion.

Contact [email protected] www.recoverypath.com

1

2

3


4/3/2020


www.naadac.org/webinars

02

Using GoToWebinar(Live Participants Only)

Control Panel

Asking Questions

Audio (phone preferred)

Polling Questions

Timothy J. Legg, PhD, PsyD, MSN, MPA, PMHNP-BC, MAC, CPH, DAAETS• Psychologist

• Private Practice

• Binghamton, New York

• www.drtlegg.com

• [email protected]

NAADAC Webinar Presenter

4

5

6


4/3/2020


Webinar Learning Objectives

Describe natural and human-made which can and do happen and how they can disrupt the lives of people in recovery.

Discuss the psychological implications of disaster and the potential negative consequences that disasters can have on personal recovery goals.

Examine elements of a “disaster recovery plan.”

Polling Question 1

Who is in the room today?

A. Licensed or Certified Addiction Counselors (CASAC, LADC, etc.)

B. Licensed Professional Counselors or Social Workers

C. Psychologists or Psychiatrists

D. Registered Nurse (RN, CNS, NP, etc)

E. Other

9

Friday afternoon

Monday evening

Thursday Morning

7

8

9


4/3/2020


Describe natural and human-made which can and do happen and how they can disrupt the lives of people in recovery.

Objective # 1

Do Disasters Disrupt the Lives of People in Recovery?

• It depends on the researcher, study, and MULTIPLE variables!

• (2008) The Southeast Asia tsunami was associated with increased substance use (Vetter, Rossegger, Rossler, Bisson, & Endrass).

• 2016 observational longitudinal study of Norwegian adults impacted by the 2004 Southeast Asia tsunami (Nordlokken, Paper & Heir).

• Weekly ETOH consumption/frequency of intoxication did not change significantly.• 18.3% of sample increased consumption & 21.1% decreased consumption.

• (2002) study found an increase in substance abuse among respondents post 9/11 (Vlahov et al.).• Cigarette, marijuana, and/or alcohol use increased among 29% of the respondents.

• 2013 study volunteers from NY city agencies impacted by 9/11 events (North, Adinoff, Pollio, Kinge, Down & Pfefferbaum).

• Increases in ETOH consumption small, and returned to baseline after 3 years post-disaster• Few cases of new alcohol use disorder or relapse.

• Boscarino, Adams, and Galea (2006) found that greater exposure to disaster associated with greater ETOH consumption at 1 & 2 years after World Trade Center Disaster.

• DOZENS of studies contradicted one another…

• “Trendy”- after a tragedy- research! A few years later- follow up (some longitudinal studies, maybe)?

• History: Event not related to study but occurs during the time of the study (could impact responses of participants)

• Maturation--the processes within subjects which act as a function of the passage of time. i.e. growing older

• Testing--the effects of taking a test several times• Instrumentation--the changes in the instrument, observers, or scorers which may produce

changes in outcomes.• Statistical regression--It is also known as “regression to the mean”– “extreme” scores tend to

move towards the average• Selection of subjects--the biases which may result in selection of comparison groups. Small

sample sizes problematic• Mortality--the loss of subjects

Others– but you get the idea!

Why?

10

11

12


4/3/2020


• Ager (2008) considered the role of “denial” as it related to those living in New Orleans & events leading up to Hurricane Katrina.

• Gargano, Welch, & Stellman (2017) found that children who witnessed the 9/11 events were twice as likely to report drinking & three times as likely to have used marijuana.

• Prost, Lemieux, and Ai (2016) considered social work students who reported post-disaster alcohol use disorder

• Cerda, Vlahov, Tracy, & Galea (2008)- higher levels of use over time predicted by ongoing stressors, traumatic events & lower incomes

• Tofighi, Grossman, Goldfield, Williams, Rotrosen, & Lee (2015) demonstrated that adaptability of a buprenorphine program can help clients maintain positive treatment outcomes despite disasters

See References

Other research…

What is a Disaster?

• Sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources (International Federation of Red Cross and Red Crescent Societies, 2020)

• Though often caused by nature, disasters can have human origins.

• Differs from Emergency• a state in which normal procedures are suspended and extra-ordinary measures are

taken in order to avert a disaster (Word Health Organization, 2002).

13

14

15


4/3/2020


Capacity- How the “disaster” differs from an “emergency” in that we typically can handle an emergency- once capacity is exceededDisaster!

W.H.O., 2002

Sources of Disaster

• Avalanches

• Earthquakes

• Floods

• Blizzards

• Wildfires (can also be “manmade”)

• Cold/heat waves

• Tornadoes

• Terrorism

• Biological warfare

• Chemical spills

• Road accidents

• Infectious disease (Wait--what?!?!?!)

Natural Man-made

Disruption?

• Work

• Family

• Friends

• Recreation

• Appointments with providers

• Support group meetings

• “Cabin fever”

• “Stuck” with family members

• Excessive “discretionary” time (free-time boredom)

• Lack of diversional activities

“Normal” Routine “Abnormal” Routine

16

17

18


4/3/2020


Polling Question 2

Have any of your clients talked to you about an increased desire to “use” or share other concerns related to their ability to adhere to their recovery goals since the COVID-19 pandemic began?

A. Yes

B. No

Discuss the psychological implications of disaster and the potential negative consequences that disasters can have on personal recovery goals.

Objective # 2

• Pre-disaster or pre-event: Activities to develop a preparedness plan.

• Disaster- Mitigation of event & its consequences – focus on delivery of aid, shelter, medical care, etc.

• Post disaster- efforts to rehabilitate and return community to pre-disaster phase

• The “Second” disaster- secondary losses:• Disruption in business activity job loss negative economic consequences

(Harvard Business Review, 2020)

Phases of Disaster (again, depending on source you read..�.)

19

20

21


4/3/2020


Psychological Response to Disaster

Varied- range from “fine, why?” to acute stress disorder to PTSD

Try to “make sense” of the experience (previous experiences, culture, & lifestyle)

Most people will return to pre-disaster state of mental health

Some will develop a variety of sequela secondary to the disaster

Some will experience exacerbations of pre-existing conditions (GAD, PD, PTSD, SUD, MDD, BPD, etc.)

• Type of disaster may or may not play a role (9/11 tragedy, Hurricanes Katrina, Rita, etc., Wars- Vietnam, Iraq, Afghanistan)

• Type of substance use disorder? VERY definite “maybe”

• Exposure to ACE’s- probably

• Co-occurring disorders- probably- but not everyone

Individuals in recovery and the impact of disasters what the research tells us and what it does not tell us

• PREtraumatic factors• Temperamental

• Childhood emotional problems by age 6 such as prior traumatic exposure, externalizing or anxiety problems. • Prior mental health disorders (panic, depressive, OCD)

• Environmental• Lower socioeconomic status• Lower education• Exposure to prior trauma (especially during childhood)• Childhood adversity (economic deprivation, family dysfunction parental separation or death)• Cultural characteristics (fatalistic or self-blaming coping strategies)• Lower intelligence• Minority racial/ethnic status• Family psychiatric history• Social support prior to event exposure is protective

• Genetic & physiological• Female gender• Younger age at time of trauma exposure (for adults)• Certain genotypes may either be protective or increase risk of PTSD after exposure to traumatic events

What about PTSD? (APA, 2013)

22

23

24


4/3/2020


• PERItraumatic factors• Environmental

• Severity (dose) of trauma• Perceived life threat• Personal injury/interpersonal violence (particularly trauma perpetrated by a caregiver or involving a witnessed

threat toa caregiver in children)• Dissociation

• POSTtraumatic factors• Temperamental

• Negative appraisals• Inappropriate coping strategies• Development of acute stress disorder

• Environmental• Subsequent exposure to repeated unsetting reminders• Subsequent adverse life events• Financial or other trauma-related losses• Social support (including family stability, for children) is a protective factor as it moderates outcomes after trauma

What about PTSD? (APA, 2013)

• What has been disrupted?• Business/industry• Education• Lifestyle/patterns of living

• Coping patterns• “Dealers” may be hit hard…

• Many people “deal” in order to “use” (withdrawal?)• Sex workers who struggle with addiction (withdrawal?)• Service industry employees (withdrawal?)• People in “essential” occupations (coping?)

What does your area look like?

(Lai, et al., 2020)

Cross-sectional study of health care workers in China (n=1257) Between Jan 29 & Feb 3, 2020

What about healthcare professionals?

25

26

27


4/3/2020


Examine elements of a “disaster recovery plan.”

Objective # 3

https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4779.pdf

Disaster Plan• What is a “disaster plan” and should you develop one?

• How do you integrate a “recovery plan” with the “disaster plan.” • In short- what they would do in disasters

• How do you plan that? what “risks” exist in your geographic area?• Epidemic should be considered a risk “anywhere” • “What if?”

28

29

30


4/3/2020


• What type of organization are you? (multi provider, state/local, private practice?)

• Develop policies/procedures that address the “who, what, when, where, how, & why” in a disaster

• Who will be the commander?• What will the chain of command look like?• What contingencies must you plan for? (consider essential processes/practices in

your organization)• What about your special populations (persons with neurocognitive disorders, people

with neurodevelopment disorders• What about cultural considerations where you work/practice• What about communications?• Law/ethics• What about Hazmat disasters?• Who can render acute medical care (CPR/first aid, “stop the bleed” training)• What resources are available in your community (EMT, hospitals, etc.)

Disaster Planning

Disaster “Recovery Plan”• Who needs them? EVERYONE!

• Integrating the existing “recovery plan” with the “disaster plan.” What does that look like? What does your client’s substance use

disorder look like?Hx. of usePast returns to useSupportsUnique risk factors

• Patient arrives at your organization/office, and--- GO!

• Collaborations with other providers (what does that look like)

• Records- paper or EMR?• Web/cloud based or on your work computer?

• Prescribing? • Opioid treatment programs (methadone or buprenorphine)• Even if you are “open” what about buses, taxis, subways, etc.? • What about people in shelters?

Ideas to Develop “General” Plans

31

32

33


4/3/2020


• Staff training? (treating stress induced conditions, psychological first aid, critical incident debriefing)

• Tele-mental health?

• Frequency of visits? Length of visits?

• How will you follow-up?

• Do you have students?

“General” Plans

Tele-mental health

• NO SHARING! • Do not share e-cigs/cigarettes, pipes, bongs or joints, or “straws” (nasal use) • If sharing can’t be avoided, clean with bleach!

• NO CONTACT!• Not always practical- some people are sex workers• Reframe conversations- avoid kissing or direct contact with body fluids, use condoms!

• DRUG PREPS- DO IT YOURSELF! • Wash hands first- thoroughly, soapy lather at least 20 seconds• Wash surfaces before and after prep. • If you can’t prepare your own; get the person who is to do these things!

• PREPARATIONS FOR OVERDOSE!• EMS probably overextended • Be sure naloxone is available• Access to fentanyl testing strips?• DO NOT USE ALONE!

Practical Advice for Patients Who Need It!

34

35

36


4/3/2020


Polling Question 3

Do you typically use harm reduction strategies in your practice, or do you insist on abstinence only as a goal?

A. Harm Reduction

B. Abstinence Only

C.Unsure

Know Your Resources!!!

• LOTS of political questions

• Addressing conflicting information from professionals and politicians

• LOTS of questions on COVID-19 pathophysiology/biology: https://coronavirus.jhu.edu/

• Coping strategies for stress and dealing with unknown

• Assisting clients when your own life is being negatively impacted

• How do we (professionals) remain calm

Responses to Registration Questions …

37

38

39


4/3/2020


Polling Question 4

What type of self-care activities have you been engaged in since the COVID-19 outbreak?

A. Exercise

B. Meditation/other relaxation techniques

C.Reading or catching up on self-improvement studies (i.e. Degree, certificate, etc.)

D.Other

E. None of the above (I haven’t had any time for self-care)

• Engaging adolescents in treatment

• Remote/telepsych sessions/guidelines: https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/blog/apa-resources-on-telepsychiatry-and-covid-19

• Caring for self/clients at home, homeless shelters, prisons, etc: https://www.cdc.gov/coronavirus/2019-ncov/community/index.html

• “Existential” questions- People are adapting!

• “Where does hope lie?”

Responses to Registration Questions …

https://travelandleisureindia.in/and-the-people-stayed-home/

40

41

42


4/3/2020


• CMS-LTC telehealth: https://www.cms.gov/files/document/covid-19-nursing-home-telehealth-toolkit.pdf

• Medicaid fee for service telehealth: https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf

• Medicare telehealth FAQs: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

• National Consortium of Telehealth Resource Centers: https://www.telehealthresourcecenter.org/

• Disaster Assistance for Small Businesses: https://www.sba.gov/funding-programs/disaster-assistance

• NEJM, COVID-19 preparedness: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0079

• Explaining coronavirus to children: https://www.youtube.com/watch?v=OPsY-jLqaXM&feature=youtu.be

• "Little Gnome" therapeutic story for kids (stories and poems for the COVID-19 pandemic): http://susanperrow.com/stories

• Telehealth Service in Infant Mental Health Homevisiting: https://mi-aimh.org/wp-content/uploads/2020/03/Telehealth-IMH-Document.pdf

• Interventions for Online Therapy with Children and Youth: https://www.guidancett.com/blog/interventions-for-online-therapy-with-children-and-youth-2020

• Multilingual book for young kids explaining COVID: https://www.mindheart.co/descargables

• My Pandemic Story: A Guided Activity Workbook for the World’s Children, Families, Teachers and Caregivers: http://www.childrenspsychologicalhealthcenter.org/wp-content/uploads/2014/11/Mypandemicstory-8.3.pdf

Resources:

• World Health Organization (WHO) Coronavirus disease (COVID-19) Pandemic: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

• Emergency Conversion to Tele-treatment: Making it work: https://youtu.be/hZW1LBrtveo

Resources:

• Adelman, D. S. & Legg, T. J. (2009). Disaster nursing. Jones & Bartlett.

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

• Boscarino, J.A., Adams, R. E., & Galea, S. (2006). Alcohol use in New York after the terrorist attacks: A study of the effects of psychological trauma on drinking behavior. Addictive Behaviors, 606-621.

• Cerda, M., Vlahov, D., Tracy, M. & Galea, S. (2008). Alcohol use trajectories among adults in an urban area after a disaster: Evidence from a population-based cohort study. Addiction Research Report, 103, 1296-1307

• Federal Emergency Management Agency. (2014). Preparedness in America. https://www.fema.gov/media-library-data/1409000888026-1e8abc820153a6c8cde24ce42c16e857/20140825_Preparedness_in_America_August_2014_Update_508.pdf

• Fornili, K. (2006). Disasters and substance use disorders: Response and responsibility. Journal of Addictions Nursing, 17, 71-77.

• Gargano, L. M., Welch, A. E., & Stellman, S. D. (2017). Substance use in adolescence 10 years after the World Trade Center attacks in New York City. Journal of Child & Adolescent Substance Abuse, 26(1), 66 – 74.

• Harvard Business Review. (2020). https://hbr.org/2020/03/understanding-the-economic-shock-of-coronavirus

• International Federation of Red Cross and Red Crescent Societies (2020). What is a disaster? https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/

• Lai J., et al. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2020.3976

References:

43

44

45


4/3/2020


• North, C. S>, Adinoff, B., Pollio, D. E., Kinge, S., Downs, D. L., & Pfefferbaum, B. (2013). Alcohol use disorders and drinking among survivors of the 9/11 attacks on the World Trade Center in New York City. Comprehensive Psychiatry, 54, 926-969.

• Nordlokken, A., Paper, H., & Heir, T. (2016). Alcohol consumption in the aftermath of a natural disaster: A longitudinal study. Public Health, 132, 33-39.

• Prost, S. G, Lemieux, C. M.. & Ai, A. L. (2016). Social work students in the aftermath of Hurricanes Katrina and Rita: Correlates of post-disaster substance use as a negative coping mechanism. Social Work Education, 35(7), 825-844.

• Tofighi, B., Grossman, E., Goldfield, K. S., Williams, A. R., Rotrosen, J. & Lee, J. D. (2015). Psychiatric comorbidity and substance use outcomes in an office based buprenorphine program six months following Hurricane Sandy. Substance Use & Misuse, 50, 1571-1578.

• Vetter, S., Rossegger, A., Rossler, W., Bisson, J. I., & Endrass, J. (2008). Exposure to the tsunami disaster, PTSD symptoms and increased substance use-and Internet-based survey of male and female residents of Switzerland. BMC Public Health, 8:92 doi: 10.1186/1471-4258-8-92.

• Vlahov. D., et al. (2002). Increased use of cigarettes, alcohol and marijuana use among Manhattan, New York residents after the September 11th terrorist attacks. American Journal of Epidemiology, 155(11), 988–966.

• World Health Organization (2002). Emergency. https://apps.who.int/disasters/repo/7656.pdf

References:

Thank You!Dr. Timothy J. Legg

[email protected]

(607) 205-3224

A N Y Q U E S T I O N S ?

Technology assisted addiction recovery. Built on research, made with compassion.

Contact [email protected] www.recoverypath.com

46

47

48


4/3/2020


www.naadac.org/impact-of-disaster-on-recovery-webinar

UPCOMING WEBINARS

Social Media and Ethical Dilemmas for

April 8th, 2020

Connecting the Continuum: How Prevention & Recovery Models Fit Together

By: Jane Goble-Clark, MPA, CPS


April 10th, 2020

Peer Recovery Support Series, Section II: Hiring, Onboarding, and Integration

By: Dona M. Dmitrovic, MHS and Mirna Herrera, MA, MTBC and Tiffany Irvin, CPRS


April 15th, 2020

Peer Recovery Support Series, Section III: Understanding the Pathway and the Process

By: Carlo C. DiClemente, PhD, ABPP


April 17th, 2020

Peer Recovery Support Series, Section IV: The Participatory Process for Solutions to Addiction

By: John Shinholser and Honesty Liller, CPRS

www.naadac.org/webinars

PEER RECOVERY SUPPORT SERIES


March 27th, 2020

Building a Successful Culture in Your Organization

By: Kris Kelly, BS, Jenna Neasbitt, MS, LCDC, MAT-R, and Philander E. Moore, Sr., MA, LCDC

April 10th, 2020

Hiring, Onboarding, and Integration

By: Dona Dmitrovic, MHS, Mirna Herrera, MA, MTBC, and Tiffany Irvin, VPRS

April 15th, 2020

Understanding the Pathway and the Process

By: Carlo DiClemente, PhD, ABPP


www.naadac.org/peer-recovery-support-webinars

April 17th, 2020

The Participatory Process for Solutions to Addiction

By: John Shinholser and Honesty Liller, CPRS

April 24th, 2020

Supervision and Management

By: Kris Kelly, BS, Jenna Neasbitt, MS, LCDC, MAT-R, and Aaron M. Laxton, MSW, LMSW

May 15th, 2020

A Deeper Dive Into Coaching Recovery

By: Phil Valentine, RCP

49

50

51


4/3/2020


Clinical Supervision in the Addiction Profession Specialty Online Training Series


Part One: The Supervisory RelationshipBy: Thomas Durham, PhD.

Part Two: Using Technology for Clinical SupervisionBy. Malcolm Horn, PhD, LCSW, MAC, SP

Part Three: Legal and Ethical Issues in SupervisionBy: Thomas Durham, PhD.

Part Four: Stages of Clinical SupervisionBy: Thomas Durham, PhD.

Part Five: How to Structure Clinical SupervisionBy: Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP and Samson Teklemariam, MA, LPC, CPTM

Part Six: Motivational Interviewing in Clinical Supervision –A Parallel ProcessBy: Alan Lyme, LISW, MAC


www.naadac.org/clinical-supervision-online-training-series

www.naadac.org/Bookstore

Addiction Treatment in Military & Veteran Culture Specialty Online Training Series


Part One: Supporting Those Who Served – Substance Use and Comprehensive Mental Health for Military Affiliated Populations

Part Two: Supporting Life After Service – Addiction and Transition to Post-Military Life

Part Three: Mental Health for Military Populations – Core Clinical Competencies for Treating Service Members, Veterans, and Their Families

Part Four: Beyond Basic Military Awareness – Cultural Competence in Working with Military Affiliated Populations

Part Five: Identifying Presenting Concerns – Assessment Competencies for Service Members, Veterans, and their Families

Part Six: Using What Works – A Review of Evidence Based Treatments for Military Populations

Series Presented By: Duane K.L. France, MA, MBA, LPC

www.naadac.org/military-vet-online-training-series

Over 145 CEs of free educational webinars are available. Education

credits are FREE for NAADAC members.

WEBINAR SERIES

In each issue of Advances in Addiction & Recovery, NAADAC's magazine, one

article is eligible for CEs.

MAGAZINE ARTICLES

NAADAC offers face-to-face seminars of varying lengths in the U.S. and

abroad.

FACE-TO-FACE SEMINARS

Earn CEs at home and at your own pace (includes study guide and online examination).

INDEPENDENT STUDY COURSES

NAADAC Annual Conference & Hill Day, September 25 – 30, 2020Washington, DCwww.naadac.org/annualconference

CONFERENCES

Demonstrate advanced education in diverse topics with the NAADAC Certificate Programs:

• Certificate of Achievement for Addiction Treatment in Military & Veteran Culture

• Certificate of Achievement for Clinical Supervision in Addiction Treatment

• Conflict Resolution in Recovery

• National Certificate in Tobacco Treatment Practice

CERTIFICATE PROGRAMS

www.naadac.org/join

52

53

54


4/3/2020


Thank you for joining!

NAADAC44 Canal Center Plaza, Suite 301Alexandria, VA 22314phone: 703.741.7686 / 800.548.0497 fax: 703.741.7698 / [email protected]

NAADACorg

Naadac

NAADAC

55

the impact of disaster o n recovery...the impact of disaster on recovery: the perfect storm 4/3/2020...

Documents