Job offer!

That I can take!

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Author: Bryan G. Stephens

Bryan G. Stephens is a former executive on a mission to transform the workplace. He is the founder and CEO of TalkForward, a consulting and training company, utilizing Bryan’s clinical and management expertise to develop managers and teams in a corporate environment. As a licensed therapist with strong understanding of developing human potential, he is dedicated to the development of Human Capital to meet the needs of leaders, managers, and employees in the 21st Century workplace. Bryan has an Executive MBA from Kennesaw State University, Coles School of Business, and both a Master’s and Bachelor’s degree in Psychology.

21 thoughts on “Job offer!”

  1. So I will be the Executive Director for a Residential Detox and Mental Health unit. The drive will be a bummer (40-60 min one way) but it is income and looks to be working for a great, great company.

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  2. Bryan G. Stephens:
    So I will be the Executive Director for a Residential Detox and Mental Health unit. The drive will be a bummer (40-60 min one way) but it is income and looks to be working for a great, great company.

    Should we call you ED Bryan?

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  3. 10 Cents:
    Are Detox Centers common?

    I’m no authority on this. I do have two stories that relate. My son-in-law had a very close friend from high school who was doing work on son-in-law’s house re-modeling. The friend had some serious dental work (extractions) done and was prescribed  pain medicine. Friend found unused pain pills in the house where he was working, took them, and later was determined to be addicted. He went into a detox facility, came out ok, after his parents spent $10,000 or more for the process. He then went to work in such a facility to help others. I also have run into multiple situations where someone has established or is attempting to establish such a facility in a residential neighborhood and gets plenty of resistance for bringing drug addicts into areas where there are many minor children.

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  4. Boy howdy, are you going to see a lot! You definitely landed a job that is critical to the well-being of this country and I know you’ll do well.

    If you are permitted to do so, I’d be interested to hear some of your observations along the way.

    Best of luck.

    7+
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  5. The issue with detox and rehabilitation centers is more one of effectiveness rather than the number of centers. One of my two part-time jobs (the other being anesthesia) is as a doc on the detox unit of a drug & alcohol rehab (I suppose they complement each other in some perverse way). About 90% of our patients are those with “opioid use disorder” (formerly drug addicts) and 10 % are “alcohol use disorder” (formerly alcoholics). Since it is quite difficult to follow patients for very long after discharge – despite the fact that every patient leaves with an aftercare plan – accurate outcomes are notoriously difficult to ascertain. I would guess that one year after discharge around 10% of patients are clean & sober. Until recently, most all programs were abstinence-based, employing 12-step recovery like AA. The individuals who stick with such programs tend to do well and improve functioning in all aspects of their lives; they stop using and they grow up, like functional adults. Ubfortunately, most patients do not do this.

    Complicating matters is the policy-level hysteria about the so-called opioid crisis. Enter the notion of “harm reduction” in the form of Suboxone (=a partial-agonist opioid, buprenorphine + naloxone, which prevents parenteral use). Since our entire society wants of quick fixes for everything, the notion that a medication can reduce cravings has taken policy makers by storm. They imagine that “medication assisted treatment” is a magic bullet. In reality, it is “medication only treatment”, with a stark de-emphasis of traditional methods like 12-step programs and group therapy. After detoxification – i.e. controlled withdrawal with reduction of symptoms – under the new regimen, patients are asked to simply show up every two weeks for a new prescription of Suboxone and that should solve the problem. The result of this approach is yet to be determined, though based upon what I see, I am not optimistic.

    This is a book-length topic. IMHO, a quick fix does not exist. What might work is long-term (6 months or more) treatment which keeps addicts out of circulation and physically unable to use – initially residential 24/7 with traditional rehab, then halfway house permitting controlled outside activities like work, with regular urine monitoring; dirty urine results in immediate and unpleasant consequences. In other words, a long term, coercive carrot and stick approach. Absent this degree of intrusion, I believe very few will ever recover. This would, of course, be very expensive, though probably not as expensive as  ubiquitous criminality occurring in support of drug use.

    The work is challenging and, occasionally, rewarding.

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  6. civil westman:
    Absent this degree of intrusion, I believe very few will ever recover. This would, of course, be very expensive, though probably not as expensive as  ubiquitous criminality occurring in support of drug use.

    Not to be Mr Knee-jerk Libertarian here (or, if you like, Jerk Libertarian), but what are the deleterious consequences of long-term use/“abuse” of these pain-killers?  I’m not asking to be provocative: I know nothing about this.  If people who are prescribed these drugs, presumably according to the usual narrative, for genuine pain relief, and then become dependent upon them (presumably [there’s that word again: I don’t know] not for relief of the original pain but due to a dependency created by the medication itself and withdrawal symptoms upon cessation), were simply offered a maintenance dose which avoided the withdrawal symptoms and craving but may, horrors!, give them some form of pleasure, what would be the short- and long-term consequences of this, and how would those consequences compare to those of criminalisation of access to these drugs, coercive measures to prevent their use, and demands of total withdrawal and cessation?

    And what is the cost, in human suffering and enforcement overhead, of a quasi-totalitarian regime where medications for chronic pain that afflicts many people who have exceeded their paleolithic shelf life, compared to simply making these palliative remedies available to them?

    (Disclosure: my own acquaintance with chronic pain dates from 2014, when a hip and knee joint blew out.  I have used only NSAIDs to cope with this, specifically celecoxib, so I have no personal experience with opioids.  But given the difference that this modest-yield painkiller has made in my mobility and day-to-day life, even though it doesn’t get me high, I’d be inclined to respond violently to any do-gooder who wanted to take it away.  I can imagine that people living with much more severe chronic pain thanks to strategic-yield analgesics would react even more forcefully to their withdrawal, even absent symptoms of chemical dependency.)

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  7. John Walker:
    I’m not asking to be provocative: I know nothing about this.  If people who are prescribed these drugs, presumably according to the usual narrative, for genuine pain relief, and then become dependent upon them (presumably [there’s that word again: I don’t know] not for relief of the original pain but due to a dependency created by the medication itself and withdrawal symptoms upon cessation), were simply offered a maintenance dose which avoided the withdrawal symptoms and craving but may, horrors!, give them some form of pleasure, what would be the short- and long-term consequences of this, and how would those consequences compare to those of criminalisation of access to these drugs, coercive measures to prevent their use, and demands of total withdrawal and cessation?

    I hear this! I recently had some extensive knee surgery and was given a liberal prescription of oxycodone. I took one pill which did not only give me the pleasant “high” but more importantly, didn’t relieve the pain. When I reported this to my orthopedic surgeon, he advised me to turn in the remaining prescription (29 pills) because they could be accessed by addicts if I threw them out. What a ridiculous world we live in!

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  8. I am with you as to the libertarian answer. In my prior comment, I was wearing my medical/professional hat. When I doff it, I would decriminalize all of it and make pharmaceutical grade drugs available at modest cost to adults. In Portugal, this has been done and I understand many live relatively normal lives. I would also make detox available for those who want it. It is unimaginable to me that the cost to society of doing this could be a fraction of the cost and harm of present criminalization and the “war” on drugs.

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  9. John Walker:
    …what are the deleterious consequences of long-term use/“abuse” of these pain-killers?  I’m not asking to be provocative: I know nothing about this.  If people who are prescribed these drugs, presumably according to the usual narrative, for genuine pain relief, and then become dependent upon them (presumably [there’s that word again: I don’t know] not for relief of the original pain but due to a dependency created by the medication itself and withdrawal symptoms upon cessation), were simply offered a maintenance dose which avoided the withdrawal symptoms and craving but may, horrors!, give them some form of pleasure, what would be the short- and long-term consequences of this, and how would those consequences compare to those of criminalisation of access to these drugs, coercive measures to prevent their use, and demands of total withdrawal and cessation?

    My understanding is that the maintenance dose would creep up and up over time, until there are major consequential side effects associated with the dosage needed to obtain the minimum buzz required to avoid onset of withdrawal.

    I will defer to our professionals to fill in greater information.

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  10. MJBubba:

    John Walker:
    …what are the deleterious consequences of long-term use/“abuse” of these pain-killers?  I’m not asking to be provocative: I know nothing about this.  If people who are prescribed these drugs, presumably according to the usual narrative, for genuine pain relief, and then become dependent upon them (presumably [there’s that word again: I don’t know] not for relief of the original pain but due to a dependency created by the medication itself and withdrawal symptoms upon cessation), were simply offered a maintenance dose which avoided the withdrawal symptoms and craving but may, horrors!, give them some form of pleasure, what would be the short- and long-term consequences of this, and how would those consequences compare to those of criminalisation of access to these drugs, coercive measures to prevent their use, and demands of total withdrawal and cessation?

    My understanding is that the maintenance dose would creep up and up over time, until there are major consequential side effects associated with the dosage needed to obtain the minimum buzz required to avoid onset of withdrawal.

    I will defer to our professionals to fill in greater information.

    The notion that the required dose would always escalate was not the case for many in the Portugal experience. A significant percentage plateaued their dose and remained on a steady maintenance dose – as with Suboxone. Generally, withdrawal symptoms can be held at bay with lower than usual maintenance doses. Genetic studies are beginning to show variability in coding for opioid receptors among individuals. It may turn out that these difference may account for the difference between those who need to escalate dose and those who do not.

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  11. civil westman:
    The issue with detox and rehabilitation centers is more one of effectiveness rather than the number of centers. One of my two part-time jobs (the other being anesthesia) is as a doc on the detox unit of a drug & alcohol rehab (I suppose they complement each other in some perverse way). About 90% of our patients are those with “opioid use disorder” (formerly drug addicts) and 10 % are “alcohol use disorder” (formerly alcoholics). Since it is quite difficult to follow patients for very long after discharge – despite the fact that every patient leaves with an aftercare plan – accurate outcomes are notoriously difficult to ascertain. I would guess that one year after discharge around 10% of patients are clean & sober. Until recently, most all programs were abstinence-based, employing 12-step recovery like AA. The individuals who stick with such programs tend to do well and improve functioning in all aspects of their lives; they stop using and they grow up, like functional adults. Ubfortunately, most patients do not do this.

    Again, I’m no expert, but my guess is a measure of the difficulty of abstinence-based recovery success might correlate to general lack of this type of personal behavior required for individuals in our recent generations. They have always been allowed to take the easy path. Without change it will only get worse.

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  12. Addicted Brains are rewired. There is no easy solution to this.

    I am not or legalization because I worked in community behavioral health. We don’t need more addicts and making things legal will give us more because more people will try.

    Again, no good answers. It sucks. What I have seen be most effective are diversion courts. Takes two years, lots of people, lots of energy and sticks and carrots. Effective.

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