Rural Recovery Resources

Mental illness and addiction are big issues everywhere — but especially in rural areas like Osceola, Wisconsin, that lack local treatment resources. As my partner, Nicole Smith, M.D., said well, “What we lack at Osceola, is we don’t have integrated behavioral health, we don’t have therapists on staff. For better or for worse, Osceola doesn’t have mental health beds.”

All of that is about to change!

Exist Media Company — Lakeland, Minn.

Osceola Medical Center (OMC), a rural health clinic and critical access hospital, has committed to rapidly creating local services for mental illness and addiction. The Osceola Community Health Foundation (OCHF) recently raised $61,000 at its annual gala to launch an integrated behavioral health program. And OMC’s board of directors just prioritized creating “psych safe” hospital beds so we can stop boarding patients in the emergency department and transferring them far from home.

“We want to be known as the people who show up in the best and worst of times for our patients and their families,” said Kelly Macken-Marble, OMC’s chief executive officer.

Many thanks to Jill Leahy, Director of the OCHF; Exist Media Company; and countless others for imaging a better future for our community. ✸

The Books Before the Big Book

About 20 years ago, I ran across this in an essay by C.S. Lewis:

Every age has its own outlook. It is specially good at seeing certain truths and specially liable to make certain mistakes. We all, therefore, need the books that will correct the characteristic mistakes of our own period. And that means the old books.*

Photo Credit: PBA Galleries

Lewis argued, “I do not wish the ordinary reader to read no modern books. But if he must read only the new or only the old, I would advise him to read the old.” He also offered this suggestion: “It is a good rule, after reading a new book, never to allow yourself another new one till you have read an old one in between.”

My reading habits immediately changed. I started reading old books—in many cases, very old books.

And so it is that we will be considering Richard R. Peabody’s The Common Sense of Drinking, which was published in 1931, at an upcoming residential recovery retreat at Hazelden Betty Ford’s Dan Anderson Renewal Center. The book contains ideas and phrases that were later popularized by Alcoholics Anonymous such as “once a drunkard always a drunkard” and “halfway measures are of no avail.”†

Many thanks to Kim Albers and Peg Schroeder for inviting me back!

* C.S. Lewis. Undeceptions. London: Geoffrey Bles, 1971, p. 161–166.
† The first edition of the Big Book appeared in 1939.

Just Me Again

I had the privilege of authoring the chapter on Alcohol Use Disorder in Conn’s Current Therapy 2023, the venerable textbook that has now been through 75 (!!) annual editions. With a little luck, you should be able read it via Google Books (Section 10: Psychiatric Disorders, Page 823).

As promised last year, I included some important new-ish research on non-abstinent recovery (“progress, not perfection”) in the 2023 edition. I also added a section on motivational enhancement therapy (a/k/a motivational interviewing) and cognitive behavior therapy (CBT), which can be conducted during brief sessions like office visits in primary care.

I’ve been asked to return for the 2024 edition. If space permits, I may include a section on ambulatory medically managed withdrawal (“detoxification”), which is feasible for many patients.

Many thanks to Rick Kellerman, M.D., for involving me in this most rewarding project! ✸

Postscript [03/03/2023]. It’s always fun to receive the physical copy in the mail. The book weighs in at around 9 pounds per the label on the box in which it arrived.

Tailoring Treatment

It’s great to be back at the MARRCH Annual Conference & Expo after a several year hiatus. This year, I’ll be speaking on tailoring treatment using the transtheoretical model (26 October, 12:30 p.m.). You can find my PowerPoint here.

The transtheoretical model is seemingly central to addiction treatment, but do we effectively use it?

  • Do we accurately stage patients upon admission and during their course of care?
  • Does our interpersonal stance match each patient’s stage of change?
  • Do we use appropriate processes of change for each patient’s stage of change?
  • Does it even matter?!

I’ll tackle these questions and much more. ✸

They Might Be Faking

It was great to gather again for the Minnesota Sheriffs’ Association’s annual Correctional Health Division conference. This year, I presented on non-psychiatric (“medical”) malingering. Here’s my PowerPoint:

We could perhaps tackle psychiatric malingering next year (hint, hint). In some ways, this is easier to deal with as presentations seldom require urgent off-site transport. Standardized tests also make determinations more secure.

Many thanks to Holly Compo, Tom Wells and Randy Willis for inviting me to participate, and for onsite support. ✸

This Is Water

Last weekend, I lead a residential wellbeing retreat at the Dan Anderson Renewal Center on the Center City, Minn., campus of the Hazelden Betty Ford Foundation. We examined the origin and nature of suffering, and some potential solutions.

We used David Foster Wallace’s This Is Water as our core text. Here are my PowerPoints that explore some related ideas:

Many thanks to Paul Anderson for inviting me to lead the retreat. And a huge thanks to Peg Schroeder for assistance with planning and onsite support.

Based on positive evaluations, it seems likely that we will offer the retreat again to all comers (not just health professionals). ✸

Top Doc 2022, and Some History

I’ve been practicing addiction medicine since 2005. A lot has happened between then and now, including regional recognition of our specialty by Minnesota Monthly in 2014.

“Top Doctors” Issue: 2014, left; 2022, right.

You can trace the history of the specialty back to at least 1954. That’s when the New York City Medical Society on Alcoholism, progenitor of the eventual American Society of Addiction (ASAM) formed. In 1983, it began awarding a certificate of added qualification (CAQ), which was still available when I entered the profession. My certificate—December 6th, 2008—is probably from the final CAQ cohort.

The American Board of Addiction Medicine (ABAM), an independent medical board, formed in 2007. I was a member of its inaugural class in 2009. This eventually gave way to the American Board of Preventative Medicine (ABPM), of which addiction medicine has been a subspecialty since 2018.

I was surprised when Minnesota Monthly notified me that I was going be included in its 2014 “Top Doctors” issue. The letter didn’t indicate which specialty, so I e-mailed the publisher. They replied, “You have been nominated in the field of Addiction Medicine.” This was a new category. Our specialty had finally achieved mainstream recognition—grocery stores, gas stations, home mailboxes!

Five of us were listed in 2014. The number has grown over time and this year includes 17 addiction medicine physicians.

Mpls.St.Paul Magazine publishes a competing list. I hope that it discovers addiction medicine before I retire. I’m only 52, so there’s still lots of time. ✸

Postscript. We intentionally run a very small practice—it’s just my longtime assistant, Kris Jamieson, and me. She’s the one answering the phone and e-mails, chasing down labs results and medical records, calling pharmacies, completing prior authorizations, and offering constant encouragement to patients (they tell me “I love Kris” and “Kris is great” all the time). Behind every top doctor there’s a top assistant. This recognition is just as much hers.

Adjust Your Own Mask

No, not *that* kind of mask! I’m thinking about the airline safety announcement. It’s a great metaphor for health professionals—it’s hard to help others when we’re struggling ourselves.

Please join me for a weekend retreat at Hazelden Betty Ford Foundation’s aptly named Renewal Center, located on its beautiful Center City, Minn., campus. I’ll be bringing together a decade of work on burnout, resilience and wellbeing, with a big emphasis on acquiring new self-care skills.

Anyone working in healthcare welcome. And, yes, Hazelden Betty Foundation is known for addiction treatment—but you don’t need to have a personal history of addiction to attend the retreat. ✸

Postscript. The retreat’s title—This Is Water—is a riff on a small but profound book by David Foster Wallace.