Metaphor or Simile?

“Writing and reading decrease our sense of isolation. They deepen and widen and expand our sense of life: they feed the soul.”

 

Anne Lamott – Author in long-term recovery

I recently attended The Sun Magazine’s Writer Workshop: Into the Fire.  A three day writing intensive, led by a number of successful, soulful, published, actual writers, who happen to teach. Man what a pleasure.

The workshop was held at Wildacres Retreat, located in the Blue Ridge Mountains of Western NC, north of Marion, in the tiny town of Little Switzerland. The trip there ended with a rainy, skinny two-lane blacktop drive coursing miles up a mountain known as Pompey’s Knob, that felt, when I arrived, like I’d passed a test, the first of more to come. Marion is the home of the Livermush Festival, which I do want to try, Livermush that is.  It’s up to you whether you stop by and try Moondoggy’s Classic Diner.

The story of how the mountain got its name and the retreat’s creation is a curious early 1900’s tale the resort staff tells with humor. Authors Sy Safransky and their hand-picked staff; Fred Bahnson, Chris Bursk and Frances Lefkowitz (and others) gave my mind a challenge and I’m the better for it.

While we’re at it, at Moondoggy’s that is, does anyone remember the venerated avant-garde composer, busker and street poet Moondog, of NYC? The 1940’s conductor of the New York Philharmonic, Artur Rodzinski, championed him.  Blind since a teen, oftimes homeless, he struck me as Manhattan’s Shaman. Since we’re riffing here, I’ll throw in that Alan Freed called his radio show the Moondog show. Freed was an early rock pioneer, probably coined the term rock and roll, was vilified for playing what we now know of as the finest classics of R&B without which there wouldn’t be rock and roll and died of the disease of alcoholism after Congress scapegoated him around payola issues, their attempt to smear “that communistic music”.

But let’s get back to my writing class; writing about writing is problematic. Novice that I am I feel a bit of pressure. It demands an even greater facility with words. I want to bring honesty, illumination, humor, simile and metaphor. Wait, is it a simile or a metaphor?

I have never written in my life, until now. Never. No big deal but it is of interest to me. I never-I mean never-did homework which may have ultimately contributed to my expulsion from high school the second I turned 16, though certainly I could list other contributors. This is not entirely accurate in that in recovery I have done inventories on paper and journaling, morning pages’ ala The Artist’s Way. Oh and I prided myself on good postcards. But that is it. Finito.

Then my boss said a great thing; “You need to start writing.” So here we are.
I have always loved to read. I was read to from a very young age (Thank God) which aided me in learning to read young and I had books around and discovered the library young and used it, and books, as a refuge.

Words are important, abyssal, often quixotic, can uplift or harm, yet, “Sticks and stones may break my bones but words can never hurt me”. Words are often imperfect, especially in the arena of ideas, are worthy of study and I love ’em. I like to learn new ones, look them up including words I believe I know, just to check.

A science-based fact and truth of writing, is;  the act of physically writing, hand upon paper (maybe keyboard), activates different areas of the brain than speaking and facilitates different healing process’.  Another fact of recovery, which I see/feel is a human fact; we all want to be heard. It’s what every child wants & needs. When they are not it sets up future adult dynamics that play out over years even lifetimes.

We want to get what’s inside out. Be acknowledged, be seen, be heard. To be heard/seen is a key element of any artistic endeavor  AND  is different than the “old” addicted self that leans toward what we call being “right”.  To be “right” signifies the ego “winning” and being in control, to be heard is to be seen, without judgement.

We all have a story, in our head and want to tell it, whether we are conscious of that or not. Recovery is often about changing our story.

These truths are at the core of the Recovery Advocacy Movement and any attempt by any group of peoples working to create consensus. To work together, to be heard and to hear, surfing our way toward the best decisions & strategies that are for the greatest good, is what consensus building is and what restrains condensation of power bases that ultimately inhibit true human needs and is how to get win/win success.

As I study writing & words now I am reminded of the fact that; in recovery I was surprised and chagrined to realize that there were words I did not know the true meaning of and I needed to grow in my knowledge. I thought I understood their definitions but really misunderstood them. Seemingly simple words like fellowship, service and support.

I had no idea what the word support meant. Pre-recovery support meant something along the lines of;  you ‘de loan me money when I asked (and I could oftimes forget that “loan”).

That you ‘de come and bail me out of jail as soon as I called.  In recovery I saw that support was something else entirely, which meant maybe you ‘de let me sit in jail instead of jumping when I called (not that that had to happen in recovery, thank God again). Support meant that you were there for me but also meant you called me on my…poop, when needed. That you cared enough for me to do that was a healing act in and of itself and my bottom was thorough enough (another thank God!) that feedback was not painful but welcomed. Or if it was painful it didn’t matter. I was open. Now the key is to stay open for the rest of my natural life.
Meanwhile, my understanding of the depth of meaning to the word support has changed, grown, morphed over the years. Allow me to walk through an example.

As previously reported, my fairly typical entrée into recovery involved deep immersion in 12 Step. I had no money, little life, little else to do so the wisdom in this immersion was evident. I went to lots of meetings, listened to many people/talks, hung out with and called the best, listened to tapes, read the literature, got a sponsor (really the best) and worked to talk honestly with him and to work the steps hard. I committed to and followed through on-often by direction-service commitments that grew in discipline and complexity as the days turned into months into years. Had fun such as going to dances and conventions where the spiritual is exponentially multiplied. And more. I began to build a new life.

A common thing happened, which was; as I grew recovery and got a life, a fair amount of that fell away. I listened carefully to advice and grew internal awareness so that I was not at risk of falling too far away, of doing so little that I might lose my way, but nevertheless I had less time for 12 Step.

What recovery grew into, for me, was a core of committed service work and sponsor. Less meetings. Less “hanging out”. I was blessed to go to conventions, attending 8 World Conventions.  (I considered those a “working” vacation.) It’s beyond emotional and uplifting, plugging in with 10 or 20,000 other recovering people in one place. Comedians working the convention would joke about how if we all “relapsed at the same time the city’ d disappear”.

Bill White portrays it when he wrote, “High intensity participation in recovery support activities is typical of early stage lifestyle changes. Such intensity usually reaches a state of moderation and balance once the new changes have been fully mastered, stabilized, and integrated into one’s life.”

That integration stage is instructive to how Recovery Community Supports look and feel.  At some point it hit me, all my supports were in place and working even if I wasn’t “working” them all the time. Support is everywhere, all around me, if I chose it, like a net underneath a trapeze artist, it’s “working” (building confidence) even when he does not fall. It’s there doing its job, growing confidence and positive energy. Various Brainiac’s write about spiral dynamics and I say we see that in everything. As I stay in recovery I grow more recovery which adds to my recovery which grows more recovery; spiraling upward. Reverse it if I return to use. I get drunk, feel bad, which supports bad behavior, feel worse, get drunk (to relieve), spiraling downward.

All the guys I knew, who I might at times just bump into out and about; the service work I’d done, the literature I read and the more I would read, the writing and understanding from that, the anniversary’s I had “under my belt”, the various other actions and symbols that represent community, because “there is no recovery that does not embrace community”, all this and more adds up to a safety net of recovery, which, in place, has healing aspects even when not in actual real-time usage. I can’t leave it alone completely, it demands maintenance, but that maintenance becomes easier as I go. The safety net under the trapeze act we call Life.

That’s what a community feels like. Thank you all for helping me be heard and part of your community.

A metaphor is an equation; A = B, a simile is an approximation; “like”.

A metaphor substitutes one thing for the thing.

A wire is a road for electrons.

Words are dreams we can hear.

A simile-to be like something-retains some irresolvable difference so it cannot be substituted.

A great book is like a great meal (i.e. nourishing)

Great words are like vitamins for the mind.

Let’s just say I need to keep working on this stuff.

 

North Carolina General Assembly Finalizes Budget for FY17

Now, with the budget finished, here’s a final update from APNC’s Mark Ezzell:

The NC General Assembly has announced a final compromise budget. You can read the entire budget here.

Regarding substance use disorder funding:

  • The budget allocates $20 million to go into a new Mental Health and Substance Use Task Force Reserve Fund to help finance the Governor’s Task Force on Mental Health and Substance Use recommendations. Of that funding $10 million is in recurring funds and another $10 is in nonrecurring funds.
  • The budget also provides funding for the Controlled Substance Reporting System (CSRS) which was included to upgrade their database and include analytical software components- about $1.2 in nonrecurring funds and $300k recurring funds. The budget also mandates physician registration on-but not usage of-CSRS.
  • This year’s budget also restores some of the cuts to single-stream funding to the LME’s that were part of last year’s budget. Under this year’s compromise, there will be a $30 million one-time transfer made this year from Division of Medical Assistance to the Division of MH/DD/SAS and another similar size transfer next year.
  • The budget also creates a 3-year, $500,000 Medication-Assisted Opioid Treatment Pilot Program through federally qualified health centers.

There are several other developments this session that are not a part of the budget, such as the naloxone standing order signed recently by the Governor and a provision allowing privately funded needle exchange programs.

All in all, this has been a very successful session for our legislative agenda and SUD community goals.

For reference: From 6/02/16; A Legislative Update on MH/I-DD/SUD IssuesA House and Senate Budget Comparison At-A-Glance

North Carolina Harm Reduction Coalition

nchrc

Greensboro, N.C. – Governor Pat McCrory joined law enforcement officers, first responders, legislators and health care officials today at the Guilford County Sheriff’s Office to sign legislation making naloxone, a life-saving opioid reversal drug that has already saved 3,300 North Carolinians, more accessible.

The legislation represents an early accomplishment of the Governor’s Task Force on Mental Health and Substance Use, which delivered a report to Governor McCrory in May recommending expanding capacity for opioid treatment services, medications and overdose prevention, such as naloxone.

Beginning at 2 p.m. today, pharmacies in North Carolina will begin making naloxone available without a prescription. North Carolina is the third state in the country to issue a standing prescription order statewide for naloxone.

McCrory signs bill widening access to overdose antidotes
News & Observer 6/20/16

The final trigger for me, to write about what a colossal job NCHRC is doing, how pronounced their accomplishments are, was their Legislative Day at the General Assembly-Law Enforcement and Community Summit on Heroin in North Carolina, May 12th. I saw Police Officer after Police Chief after Sheriff after State Bureau of Investigation Special Agent! (Ret.), get up and talk about their efforts to grow and support naloxone use by the troops as just a beginning gambit in supporting people toward recovery. Ret. Police Chief Jim Johnson, of Huntington, VA, told a compelling tale of his reversal; how he traversed from classically dead set against these ideas (“a staunch opponent of needle exchange”), through horrific addiction (the “communities’ youngest overdose death was 12 years old and oldest was 77”) to complete promotion of these ideas “because they work”. As a guy who’s been on the other side of the law, who’s regularly broken out in the hives most of you call hand-cuffs, this was inspiring. We are now on the same side working together!

Allow me to repeat-I’m not a bleeding heart. The Police aren’t hired to necessarily be Social Workers which is my way of saying they have a job to do. I have nothing against consequences for bad actions, but these are drastic times and they call for different approaches. And-we have proven we cannot incarcerate our way out of addiction.

Allow me to back up a bit.

Early on-starting some twenty years ago- my work was in homeless agencies and they often had a Harm Reduction wing. An agency I worked at for 8 years received the first Open Society Harm Reduction grant issued in the USA. It went out to three cities, as a trial project, to be expanded as they showed success. This put me into a learning curve that was challenging to my innate belief structure. I want to elaborate but first I need to say; though this Open Society approach had some new ideas, harm reduction (HR) is as old as Hippocrates. A Physician of Classical Greece considered the Father of Western Medicine, he preached the Hippocratic Oath, still in favor today. The Oath was a paper written sometime around 400BC (we think) it is summed up as, “First, do no harm”.

To my eyes, harm reduction really hit with the founder of modern nursing, Florence Nightingale. It’s the nurses who bring harm reduction to the people, especially for the indigent. So harm reduction is nothing new. Applied to substance use treatment, it’s true that all manner of treatment programs would not “tolerate” resuming drug use, “relapse” they called it, and ask them to leave. To kick someone out of treatment, for doing what they do, seems foolish now with hindsight, but was the norm back 30 years ago. Also, if someone’s not really in recovery than they didn’t really relapse, so that word is considered passé and no longer useful. Return to use is the phrase now. This illustrates a way harm reduction can and has entered the field, in some cities, but it has grown into much more, starting with needle exchange and moving to naloxone dispensers. This is where my learning curve began and I originally felt internal resistance to HR.

LEAD

The only thing that matters is: not my internal belief structures but that, like ROSC in general, these directives actually work. Needle exchange does not just reduce HIV transmission-it definitely does that-BUT ALSO significantly reduces accidental needle-sticks for arresting officers. That alone is reason to do it. Plus, if they are signed up in the program then they are engaged. That becomes the portal to services and treatment options for people using drugs. Trained staff can keep their eyes and hearts open for that window of opportunity that means movement toward a fuller recovery. You understand, it takes caring and skillful people to do that work and NCHRC is made up of just such people. That means more people getting into more recovery earlier. Harm Reduction! What a concept.

Now we’ll back up again, because the real picture is Law Enforcement Assisted Diversion Programs (LEAD). LEAD “diverts’ people to a case manager/social worker before they get involved with the criminal justice system. A comprehensive training/program/body of knowledge that starts with the Police and diverts non-violent offenders into treatment and away from jail. Immediately we are saving money because it’s cheaper than lock-up and shows significant success with percentages of people who do not re-offend. Fayetteville Police have a LEAD program going, under the direction of Captain Lars Paul and he reported great successes. Data is coming people! On the coast, New Hanover/Brunswick Counties are looking to add LEAD and out west, under the excellent, willing direction of Waynesville Police Chief Hollingsed, Haywood County is adding LEAD.
Thanks to NCHRC efforts, there are 77 NC police departments dispensing naloxone.

If we see a ROSC as a spectrum of care {disease living on a spectrum too} then NCHRC (and others) are representing the “left” end of the spectrum, under the Prevention label, with; drug overdose prevention & education, HIV/HCV/needle-stick injury prevention and LEAD. If you’re familiar with all this the next logical question/issue is; how do we get more beds to handle the new people???

77

Beds are over toward the other end of the ROSC spectrum but it is clear to me, I actually see efforts that the NCHRC are making, to advocate for and grow more beds in the state, as they go about their work. Now what they need is support from all of us!
To do some fact-checking I sat down with Tessie Castillo, Advocacy and Communications Coordinator. I’d call her the #2 under Executive Director Robert Childs, but they’re not much concerned with titles or anything else except what’s going to get results today! It was both a revelation and confirmation for me to find out she had previously worked for the American Federation of Labor and Congress of Industrial Organizations (what we know as the AFL-CIO); the revered Worker’s Union of my Detroit youth, a national trade union center and the largest federation of unions in the United States. Clearly she was born with a desire to make a difference and these HR initiatives are bringing measurable differences to the streets. It has been said that working to make a measurable difference is one of the four core actions that bring fulfillment. (The other three being; live a life of passion, create financial independence and eliminate unnecessary struggle)
BTW, NCHRC accomplishes all this with only 6 full-time people, and a few part-time and with (almost) NO tax dollars. They were receiving some tax dollars but that is ending and all other financing comes from various private streams; foundations and such.
HR and LEAD and like initiatives have been working successfully, from Fayetteville to Albany to Santa Fe to Seattle, across the USA, saving money and lives while getting great outcomes, mostly driven by the pain of wide-spread opioid addiction (and the attendant overdose deaths) and is proven beyond any doubt.
I have to add that North Carolina has many prevention warriors working and other harm reduction efforts, including Project Lazarus, led by Fred Brasson and they all deserve our support.

Abundance


The Orlando shooting last week brought home my thought, at the end of my previous email, of how much pain I see in the world. It is odd to me, how I live in a kind of paradise-recovery, friends, loving wife, love all around, fantastic food/health, fulfillment, great work, beautiful nature and much much more; while viewing all that outside pain.

As I walk a very imperfect spiritual path, all of it compels me to say:

A fundamental spiritual principle is to reject creeds, policies and behaviors that inflict pain, suffering and deprivation on fellow humans. This principle needs to be extended; we should not just seek an absence of pain and suffering, but also the enhancement of human relationships and the enrichment of human experience. Then kindness can begin to rule and thriving becomes the natural way.
All the great teachers who have arrived during our known written history, expressed a “universal spirituality” in their teaching systems:

“Hatred does not cease by hatred, but only by love. This is an old rule. Hurt not others with that which pains thyself” Buddhism

“You shall love your neighbor as yourself” Christ

“Wherever you go, wherever you rest, may the peace of Good Allah keep you and everyone blest. None of you truly believes until he wishes for his brother what he wishes for himself” Islam

“What you don’t want done to yourself, don’t do to others. To be in one’s own heart in kindly sympathy with all things; this is the nature of righteousness.” Confucius, 6th Century B.C.

“Do not do unto others all that which is not well for oneself.” Zoroaster, 5th Century B.C.

“What does the Lord require of thee but to do justly and love mercy, and walk humbly with thy God?” Judaism

“Chose thou for thy neighbor that which thou choses for thyself.” Baha’i

Etc., etc. When what we do helps everybody win, then we’ve won.

From Richard Rohr’s Daily Meditation

“Unfortunately, most of us have been trained to strive for perfection by willpower and determination. In men’s work we call this the heroic journey. Self-assertion and striving characterize the young male, and this is the shape his ego takes. Yet all spiritual traditions at their more mature levels teach that the soul must be receptive…….and simply accept love, without heroic effort. It is a path of descent more than ascent, unlearning more than learning, letting go more than any performance principle. It takes a long time to believe this. If we try to fix ourselves, we’ll do it with the same energy that caused the problem in the first place–which only strengthens our ego style.”

Asheville Recovery Community Center

As stated in the last email, Recovery Community Centers are sprouting up across the state, including Asheville. Below is an information release for those interested in Asheville’s progress.

Sunrise Community!

Yes, we are now Sunrise: A Community for Recovery and Wellness, a new nonprofit entity.  We have a new office space at N Louisiana Ave Suite C4 in addition to continuing our partnership at Kairos West Community Center at 742 Haywood Rd, both are in 28806 zip code.  The Louisiana office is going to be the administrative hub while we continue to outreach the surrounding area.  We are going to need a lot of help to establish the first Recovery Community Center in Western NC and we welcome one and all to the process. We need help with advertising/social media/marketing.  We need accounting help.  We need volunteers (in or out of recovery) to populate the office.  We need ideas (although we have a lot of our own at the moment).  We continue to add to our core missions:

  • Peer Support for community outreach and recovery
  • Recovery Coaching
  • Peer Support for single mothers with addiction challenges
  • All Recovery Meetings (for Community involvement on all levels)
  • Jail in reach/outreach/diversion
  • A Hope Shelter every third Saturday
  • Recovery Support Groups (we want to add to this)
  • Warm Line
  • Jobs for ex-offenders and advocacy
  • Better pay for peer support (we will have paid positions slowly being introduced as cash flow improves)
  • Recovery and Wellness Radio
  • Peer University (free CEUs monthly)

So please write or call us!  We will be “open” this Monday as we renovate the space.  We are shooting for a July 1st “open house”.  If you have living room furniture (couch!) to donate, let us know.

Also, welcome Lexie Wilkins as our “first” employee with three more positions to follow.  His duties include day to day oversite of Center and is our “super peer, with his 12 step and MRT experience.  We need more women peer supports for jail inreach/support groups.  Also welcome back to Lynette Sherrill who helped us at the shelter while “interning” with us.

We have a new website, should be up and running this weekend:  sunriseinasheville.org crafted by Lone Bird Studios (thanks Chris K!)

Sincerely,

Kevin Mahoney NCCPSS, Executive Director: Sunrise Community’ WRAP & MRT certified peer, Recovery Coach /CCAR Peer Trainer /RHA and Cardinal Innovations MCO

Everybody’s Got a Hungry Heart

Have you seen the documentary The Hungry Heart?  APNC presented it at their recent conference-accompanied by the Director Bess O’Brien and Raina Lowell, who was featured in the film.

A poignant, honest, winter grey, and hopeful telling of one small-town Vermont Doctor’s turn from a regular Pediatrician toward Addictionology due to so many of his kids ending up addicted to pain pills as they went through their teen years. I recommend it highly as the current media hoopla around our waves of opiate addiction has shoved this recurring issue into our collective faces again. The movie has many benefits in its truth telling. One I love is this whole issue of our need to end denial.

Various factors have confluence together in my psyche to make me want to and even enjoy the act of exposing and discussing the problems of society. Allow me to back up.

As the scapegoat in the family I was inclined to point out stuff or ask questions about that which was unspoken or unacknowledged. My family had the usual laundry list of secrets, nothing too hideous considering the spectrum of life in general but we did have secrets and pain and it clearly dominated how we functioned. I believe that family/early childhood deeply influences/imprints us but being the kid who pointed out that the Emperor had no clothes was a trait I was born with.  I came into this life with it, which is another way of saying genetics (or past life). Then something happened.

After some 29 years of cycling through and around drug dependence/addiction a moment of Grace freed me from the obsession to use drugs and I was literally set free. This moment happened during my third day in detox, a detox attached to a long-term recovery program which I entered.  This being 23 years ago and on a low budget, this program was quite traditional for the time which meant a lot of 12 Step meetings. In my newly liberated state I took to meetings like a duck to water.  In my newly transformed state the idea of exclaiming, “My name is Jimmy and I am an addict” made perfect sense.  To state to the world-if only in the meeting- “I’m an addict”, after so many years of denial, was empowering and began a life-long search for healing.

That, converging with my childhood scapegoat dynamic, gets us to here. Again I’ll step back a bit; a take-away from all that is; once one accepts something-even if we don’t like that something-that is when change begins. It literally sets change in motion. This is an energetic law.  Once we accept the truth of something we are half-way home.  My spiritual moment/drop of Grace actually gave me full-on surrender to the fact that I suffered from addiction and acceptance and surrender makes it ok, makes it good, actually begins transformation.  To see reality, to at least accept reality is the process that begins change!! I repeat, ending denial, about anything, and seeing honestly means we are half way home!

All this adds up to me wanting to exclaim the facts and truth about our societal problems, because shame can be busted if we get honest. Since we’re half way home once we know the problem I say, let’s get to exclaiming. How can we make something better if we don’t first identify the problem? So let’s not just say it lets shout it from the rooftops!  It brings to mind the line from a spiritual book, “For there is nothing hidden that will not be disclosed, and nothing concealed that will not be known or brought out into the open.”

Of course, I have to be most honest with/about myself first before I get to proclaim anything from any rooftop.  Gulp. So I need a process, a spiritual path in place to support my process of change.

Serious research shows that most spiritual paths have deep similarities and one recurring theme is the need for regular inventories.  I need to check myself on a regular basis to know my shortcomings (and strengths) which gives me a guide to lead me to growth/change/healing.

All the serious religions of the world actually have this within their dictates and doctrines.

Just as individuals walking the spiritual path can benefit from regular inventories or introspection & contemplation, as the Mystical Christian tradition names it, so would all organizations benefit from said work.

Which leads me to my friend Chris Budnick’s inventory he gave to the world; An open amends letter to those with substance use disorders, your families and your community.   You can read it there.   AND   You can hear it here.

His willingness in this is touching and feels vulnerable. Honesty, open-mindedness and willingness are key spiritual principles we can never have too much of, including as a society. There’s lots of reasons why a person becomes a friend.  He’s a friend because of his heart and humor and willingness but also, for me, we have a similar shared background. He has the experience that, if we live long enough, makes us experts, in the best way. Lived-experience recovery, some two decades in treatment work, plus serious historical research, and plenty more adds up to a bigger picture which led him to make this amends proclamation. He also plays semi-pro, fast-pitch, hard ball! All that makes me want to listen up when Chris speaks.

His talk wasn’t universally loved or embraced. This stuff makes many people nervous which is telling. I have watched groups, including Providers who should know better, resist the truths of all this. Once more I shall back up.

When the unconscious is largely in control, we unconsciously use the three defense mechanisms as classically defined: denial, rationalization, and projection. We project over there what we don’t want to deal with in ourselves. The whole point of increasing self-awareness is to get better or at least give ourselves choices.  There’s no real recovery without Grace, and an actual spiritual benefit of Grace is a natural humiliation to the ego, in that Grace is freely given and free gifts say nothing about me. This makes everything right sized.

This idea of people/groups needing to do an inventory, to do spiritual footwork, to assess strengths/weaknesses, giving direction toward change that improves things, is deeply embedded within the transformational nature of recovery and actually essential to change. The pain of life drives us toward change and the insight of inventories helps us purge the past to illuminate the future. We want to avoid letting the ego run the show as it leads to consequences and periodic inventories give us practice at submerging the ego. Ego deflation is painful, which means resistance to this process, resistance to change, is understandable and not necessarily a sin, but let us all now proclaim our intention to push through that resistance and forge ahead into change (all the while laughing together at how uncomfortable it can make us feel at times).

That’s what we want those with drug problems to do, so we might as well walk our own talk.

Another well-made movie, from another true story, that displays how ungodly hard denial busting seems to be for us humans, is Spotlight.  I highly recommend.

As I listen to the news, it’s clear this world’s in a lot of pain. Make no mistake; There is a way out. We know how to walk into the light and it starts with recovery.  Inventory, Amends, Forgiveness & Service = Love

Medicaid Development

bullworthThere’s a lot of press/action/movement on the Medicaid front for North Carolina and I’ve been trying to make sense of it all.

Here’s what a press release says:

“The N.C. Department of Health and Human Services on March 1, 2016, unveiled an innovative, multi-year draft plan for reforming North Carolina’s Medicaid program to drive better patient outcomes, higher quality patient care and more cost certainty. This comes after the September 2015 passage of historic Medicaid reform legislation, achieved under the leadership of Governor Pat McCrory and through the efforts of a supportive North Carolina General Assembly”.

The webpage found at this link, http://www.ncdhhs.gov/nc-medicaid-reform contains links to the following documents:

  • The Draft Medicaid Reform Waiver Application (Section 115 Demonstration)
  • A Medicaid Reform Report the Joint Legislative Oversight Committee on Medicaid and NC Health Choice
  • A presentation of the Draft Waiver and Report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice
  • Medicaid Talking Points
  • A Press Release titled: Medicaid Reform Plan Offers a North Carolina Solution.

“The public comment period for the draft Section 1115 waiver application opens March 7, 2016. Please visit the web page on March 7 to see how you can submit comments on the waiver application and other Medicaid Reform items”.

Please see this link below regarding the dates, times and locations for the Public Hearings on the 1115 Waiver.
Then someone pointed out that:
The waivers allow for expansion of services (payment for these services) outside of what Medicaid typically covers. Anything related to SUD begins on Page 16. of this document.

Here is a Fact Sheet put together by the NC Council of Community Programs.

They have an upcoming Spring Policy Forum June 20-21in Raleigh: Medicaid Transformation: A Closer Look. Here’s a link to that information.

Here’s what the NCSEG-North Carolina Stakeholders Engagement Group says; Medicaid Reform 101

Then this came out:
NCDHHS Leaders Propose a Medicaid Reform Plan

Last month, the leadership of the NC Department of Health and Human Services offered a three-year plan to the Joint Legislative Oversight Committee, which takes the State from a fee-for-service system to a value-based prepaid health plan. DHHS will submit the state’s waiver application to the Centers for Medicare and Medicaid Services (CMS) by June 1. It is expected to take at least 18 months to receive approval. Once approved, Medicaid reform will be implemented over the following 18 months. Medicaid beneficiaries will not see any change in services during the three-year interim. More information here.

It’s complicated.

I say:
Medicaid is a beast. Which is to say I have compassion for those charged with administering it. A complicated, lumbering beast. I do not (necessarily) mean bad or anything negative, but my MO is embracing what can be condensed into simple and Medicaid is not one of them. There are plenty of things; issues/topics/studies that do distill down, but Medicaid just ain’t one of them. So, I have empathy for all who must manage it, right on up to the Governor.

I have thoughts and ideas, starting with what has worked in other locations on the planet. Keep it simple means review and study so you do not have to reinvent another wheel. Of course there are numerous cultural concerns that make local creation essential. Health, real health is a deep and dear subject of study for me and that is related to Medicaid. There is a lot we could do to improve our overall health in America and it is similar to what we could do (and what is lacking) in treating substance use disorders. Which means I am apt and prone to look at it and it’s still hard to grasp solutions. That’s when art is useful, it can convey what linear thought cannot.
What I am reminded of and invite you to watch is an 18-year-old movie I saw again, the hilarious, truth-telling “Bulworth” starring Warren Beatty.

Have you seen it? If not, get on that Instant Netflix site tonight! It sums up this issue well. I remember when it came out I went opening weekend which meant a packed theater and as the movie unspooled I was bursting with laughter and over time I realized I was often the only one laughing in the whole room. Once over, as people got up to leave, I looked around and asked, “Wasn’t that great?” and noticed people, how-you-say kinda sliding away from me quietly with a, “Don’t talk to the strange man” look. I was floored. What happened to us America? The movie was (and still is) courageous, brilliant, hilarious, truthful, well-done, with a stellar cast. It co-stars Halle Berry, Oliver Platt, Don Cheadle, Paul Sorvino, Jack Warden, Amiri Baraka- (poet LeRoi Jones) and others, what more could you ask for!? The pivot point of the story is around health insurance companies, who, to quote the movie, “get 27 cents of every dollar they make”.

Aside from laying out the lies and truths of the health insurance game, it dissects race relations in America, poverty, and plenty more. Still managing my Spoiler Alert awareness, here’s a snippet from Roger Ebert’s review; “Bulworth is in trouble. He hates his job and his life, and has just lost millions in the market. So he puts out a contract on his own life and flies back to California thinking he has three days to live. His impending death fills him with a sense of freedom: At last he is free to say exactly what he thinks, and that’s what he does.”

Thus hilarity (and truth) ensue. The idea of impending death freeing us to tell the truth is a deeply appealing storyline to me.
Health insurance has also been on my mind due to reading reports of the NC Legislator’s desire to: “Shift management responsibility of Medicaid to a new agency called the Health Benefits Authority, and create a corporate-like structure to manage the Authority. Under this proposal, the new Authority would contract with three healthcare providers to provide services to LMEs/MCOs.” Put another way, it’s been said, “the program envisions management by regional Provider Led Entities (PLEs), statewide private managed care companies and regional LME/MCOs for MH/I-DD/SUD services.”
Then I stumbled upon “Bulworth”, after all these years, and here we are.
Illness/health and insurance, including the Affordable Care Act, have been at the top of the American zeitgeist for a while and for good reason. As stated, my desire is always to distill it down, make it simple whenever we can. Yet I must grant that Medicaid/Medicare are unwieldy beasts and concerns the Administration has about Medicaid are valid. Hence why we need to start with truths and grow a vision from there.
“Bulworth”, co-written, co-produced, directed by, and starring Warren Beatty, actually won an Oscar for Best Original Screenplay. But it never had a chance to really reach the public. Just to get a glimpse of how truth-telling this movie was, read what Wikipedia said:
Bulworth was made in complete stealth and released by 20th Century Fox only after protracted contractual wrangling, only for a brief period of time, and practically without any publicity. As Peter Swirski reports in his study of this film, “after 20th Century Fox backed out of producing Dick Tracy, Beatty used the leverage of a lawsuit to wangle unprecedented artistic freedom,” disclosing only the barest outline of the story and essentially duping Fox into bankrolling the project.
Epic multi-national media conglomerate that they are, Fox never would have bank-rolled this much honesty.
See this movie!

Next acronym (in the movie vein): INPSISB- “It’s not personal Sonny, it’s strictly business”. – Michael Corleone