Professionals In The Field

I went to school to become a nurse in 1975. My expectation was that whatever field I chose to go into would develop and grow with time. I was not disappointed. It has been an amazing journey discovering and uncovering wonderful things. There were many concepts that I could barely dream of like the transplantation of organs from one human body to another that enabled the recipient to live full and productive life. There have also been many unimaginable technological advances in that time.

My mother was also a nurse. In her day, the wars were with the diseases of polio and tuberculosis. She was stricken with polio as a teenager. She was apparently fully healed from the very ailment she saw her classmates crippled with. After experiencing the iron lung machine and the care of the nurses that helped her, she decided to dedicate her life to being a nurse. This had been her bargain with God if she were healed. She kept her bargain and lived to see polio and tuberculosis eradicated in her lifetime.

The wars I experienced were different: they were with cancer, addiction and AIDS. I was in the “death and dying” business as a young nurse. Cancer wards were merely places to die when I was a young nurse. I had eagerly listened to tapes by Dr. Kubler-Ross between shifts and on breaks in the hospital wards. She was the only one I found who had information on how to deal with death and dying. We nurses did this, not through school but on our own, while we worked in the hospitals. I decided to embark onto school for Counseling Education. I was “counseling” the families as they were preparing for the death of their loved ones, anyway, and secretly.

It was the doctor’s prerogative to decide if and when to let the patient know their diagnosis. Nurses were not to discuss the patient’s condition and follow the doctor’s orders. We nurses were secretly “counseling” the families as they were preparing for the death of their loved ones. We acted against the orders of the doctors and hospital. It was very risky because we knew that our jobs were at stake.

I wanted to be able to not have to do this in secret. I felt it was not dignified or right to basically lie to these families in letting them think there was hope of recovery. The doctors wanted to do more tests that simply served to prolong the denial and suffering. (By the way, it was a teaching hospital). This illusion led to much greater suffering for the patient, their families and loved ones than necessary.

We nurses did a lot of lobbying. We wrote in protest to our Hospital Boards and other institutions. We were on the front lines and saw this suffering first hand. We knew we had to do something about it. I have lived to see our protests develop into the wonderful thing we now call “hospice”. This has revolutionized the way we treat our dying family members. I have lived to see cancer not be a death sentence. I have lived to see the development of hospice and dignity for the end of life. It has been a wonderful journey and experience. AIDS has come along way too. No longer does it have the death sentence that it did in the 1980s. The newer medications have prolonged life. The world has been changed immensely over the years for families and people with cancer and AIDS.

Addiction, however, has been a completely different story. This is the story I must tell.

I remember working with alcoholics as a nursing student. My experiences in the emergency room led me to believe that addicts were horrible people. They would often be violent and belligerent as well as manipulative. We often had to strap them down on the wards because they were out of control. I worked in the first alcohol treatment CARE center in Albuquerque, New Mexico in 1975. We in the medical profession didn’t know if our approach could work. Putting a unit into a main medical hospital that could possibly treat alcoholics was an enormous gamble at the time.

I was assigned to this unit as a nursing assistant because nobody wanted to do it. I was eager to learn so I accepted the assignment. I was given my orientation for that CARE unit with the actual patients. It was thought that going through the same program they did for 30 days would be the best way to teach us. It was a wonderful education. I saw the alcoholics as people, older of course than me; I was in my 20’s. They were charming. I loved them and became attached to them. I was devastated to watch, after discharge, how fast their reason failed and most of them would relapse. I no longer recognized them.

The families were devastated. It was a true mystery how that could happen. After all, I was educated right along with them. All they had to do was not drink, follow the doctor orders and go to AA. Right? I wanted to learn more.

I have worked in the treatment industry, which later came to include drug and pill addiction. I have worked as a nurse in psychiatric hospitals. I started to see that some doctors were getting patients addicted to pharmaceuticals. Most doctors that hadn’t worked in the treatment field were unaware of such things at the time. I started to see they were diagnosing and actually aggravating the very affliction they were intending to treat.

I had brought new information from California, where I had worked for a while at the Scripp’s Hospital alcohol program. I returned to New Mexico with what was seen as radical information. The staff in the psychiatric unit was not happy with this groundbreaking information or me. The time came for a serious confrontation.

I was the head nurse of the locked psychiatric unit. We had admitted an obviously intoxicated and drug addicted young woman. She had been admitted during the night having taken an unknown amount of street drugs. She had been a regular and was well known to the staff to be a troublemaker. The staff psychiatrist, Dr. W** was known for giving her patients whatever prescription they wanted and also exceeding recommended dosages. We didn’t know what was already in the patient’s system and Dr. W** still ordered whatever the she wanted. I refused to fill the order.

Another psychiatrist who was substituting for Dr. W** came in and spoke to me. I explained what I had learned about alcoholism and drug addiction. He listened politely. Then he said that it was much easier for everyone if we just gave the patient what Dr. W** wanted. I refused to follow orders. After several calls to the nursing supervisor and then the medical director, I was sent home and written up.

The medical director, a well-known alcoholic to the staff, was retiring and wanted me written up to be an example of insubordination. I was disciplined by being given rotating shifts on the units that nobody else wanted to work. I was watched constantly. Dr. W** told the hospital in no uncertain terms that I was not to treat or be assigned to any of her patients. Although Dr. W** privately thanked me for helping her with this patient, she publicly would do no such thing. I was ostracized for over a year and made the decision to leave and go back to San Diego.

A former psychiatric nurse instructor from my nursing school became the supervisor at this hospital, and was clearly pill addicted. No one acted like it was happening. Ironically, she would rescue nurses that were alcoholic and privately make sure they went to rehabs so they could return to their hospital jobs. It was a very confusing time for me. I had begun to attend to Alanon meetings. Luckily my sponsor was an old nurse, and she gave me sage advice. She told me to stay on my side of the street and do only what I could do and nothing else. What happened wasn’t my business, it was God’s business, she said, but the footwork was mine. I was to only do what was in front of me every day. It was a hard initiation in the work of Alanon but I believe it saved my job and my sanity.

It was during this time that a new medical director had taken over. I decided that I would tell him what was happening when I was leaving the hospital. This way it would be off my conscience and I could leave in peace knowing that I had done my best. The first of a series of miracles occurred when I told the new director what was happening in his hospital. He privately told me he was a recovering alcoholic. He also said that he had reviewed my charting as the first executive thing he had done. Not only had he seen that I had saved the patient’s life, but had also saved hospital from a lawsuit by my actions and charting. He asked me if I would head up his new alcohol and drug treatment program. He thought he had gotten rid of some of the problems but said that he had instead “reshuffle the same deck” and was sorry I had to go through all that. He happily gave me his recommendation to a sister hospital in San Diego, which he said was a fabulous place to live.

Years later, I heard through the grapevine of nurses back in New Mexico that Dr. W** had been sued by the now recovering patient. I had heard that Dr. W** had mentioned to one of the former nurses to tell me if she ever saw ”that brown-haired little nurse” that I had been right. She had unwittingly addicted her entire practice and she was truly sorry.

These were the first of a series of experiences to come as I entered the hospitals and the field of addiction treatment. It has been a long journey. Every experience was just as miraculous as unusual. I don’t believe any of it has been an accident.

My father was a doctor. I have great respect for their training and dedication. Doctors enter the field of medicine because of their desire to help humanity with their suffering without causing harm. Most would be horrified, as was Dr. W**, to see what they have done. Few doctors would have been legally forced to look at their addicting practices. I believe there is a healthcare crisis in our country. Healthcare providers are stressed out with the pressure of their caseloads, private practices and time constraints. “There just isn’t enough time for this education.”

No longer do we talk amongst ourselves as treatment providers. We are further discouraged due to the HIPAA laws. It is much easier to give a pill and 5-15 minutes of education (if any) and send a patient on his way. The addiction issue is now much more complicated that it ever was.

I have recently decided to do something more about the abundance of information available that is not being disseminated about addiction. There is so much that can be done to help addicts and alcoholics recover. It seems to me that the current trend is about making money, especially by the pharmaceutical companies. The pharmaceutical companies are the only ones educating most doctors. There are thousands of people who are being addicted, unknowingly, by their doctors and enabled by their therapists.
We are like one big dysfunctional family. If we count the healthcare profession as part of the family, then the vision widens.

I had originally been trained to focus on the individual. With family systems theory training I had been taught in family therapy, I then focused on the family. I had forgotten the significant aspect of this “family”. I had been sabotaged and consistently undermined by my own “family” of colleagues and supervisors.

The men and women of the healthcare system who have been trained to alleviate, help treat and possibly cure suffering was a good thing. Like the immediate family, we meant well. We cared for and dedicated our lives to healing the sick. But in treating the sick, we have become sick ourselves. Arrogance and misinformation became our obstacles. Not learning from our history meant we were doomed to repeat it.

I realized this was what was missing from education about the disease of addiction. I understood this was why we were going backwards and not forwards. I had been trained initially from the father of intervention, Dr. Vernon Johnson. I had lived to see the schools produce the “student assistant programs” to address these issues. I watched the development in businesses take this help as their own in the form of “employee assistance programs”. Rather than lose their employees to this disease, they would prefer to help them and save their lives as well as save the company money. Much like they would treat any employee who had suffered from heart disease, diabetes or cancer, they treated the addicts compassionately. I had watched as nurses had “nurse assistance programs” and doctors have their “diversion programs”. We helped the impaired nurse or doctor, instead of taking them to jail, losing their license and years of service gone and ending in shame. I had watched with joy as my colleagues entered as these programs saving their legacy along with saving their lives. They were often the most loyal of employees after having the opportunity to have their lives saved by the company or the state. They were even more dedicated to the business of saving lives and healing, having been healed themselves, causing their humility to lead the way.

I watched as these programs lost their funding. I have witnessed the demise of these diversion programs for the doctors and nurses in California. Practitioners were simply were charged and jailed. And as is true of most of the prison population, they became another statistic of this disease, another casualty. It is not secret that the jails are filled to beyond capacity with people suffering from this addiction. Our society is punishing them rather than treating them. This is our shame. It is a huge social issue of epic proportion. I do not have an answer for it. I am watching as the problem continues to get worse and worse. The children being born into families with addiction have a genetic pre-disposition and the disease is often being passed on. Our schools are now filled with special needs. The majority of these children have been labeled with the names of the brain dysfunctions. Most are treated with medication. Some medication, which is absolutely addicting, is now being given to children who have that genetic predisposition for addiction. Who is educating the families and the teachers? Who are educating these doctors? Who will listen?

I was a teaching intern in primary and secondary schools in 1973. We might have had one “hyperactive” child in the entire class. They were an anomaly back then. Nowadays, the teachers are definitely not educated about these illnesses. Most are mostly unable to keep some kind of order in the classroom. Now their very lives are at stake.

I created and developed a unique Student Assistance Program I in Imperial County, California in 1990 and 1991. Now 25 years later, to my surprise, this is still continuing today. It is one of the few programs in the country with that kind of history. Funds for the program dried up within the first few years after its implementation.

The woman in charge of the County Office of Education truly cared for her community. My program would not have been chosen without her insight and careful planning. We both were women in Alanon we later found out. We recognized the language of the heart when we spoke. She recognized through my language and training that I understood addiction and recovery. She chose my program after receiving bids from all over the country. She wanted something unique for each school district. She knew that it had to be long lasting and yet that could be used for the diversity and huge range of population that was considered Imperial County. We not only intervened on the students but also on the staff, supervisors, janitors, the teachers and student aides. It was because of her foresight that the program continues today. This was another miracle that happened in my life that I will always remember with great joy.

I have just attended another “early childhood mental health treatment” symposium. So much information and education was available, but how can it be mainstreamed into the workplace and make it publicly available?

I am proud of the city of San Diego. My Recovery Coaches and I attended the 6th annual early childhood mental health conference partnering with the UCSD School of medicine. We were blown away by how much new information and services were actually out there. We had a booth at the conference and met several outstanding people in the community whose hearts and souls are at the forefront of the crisis. It’s especially heartening to know San Diego is the pilot project for the nation in heading up changes.

For example, did you know that we are the first Trauma Informed City? We are paving the way for the entire country. With all these systems changes, we will be the first trauma informed integrated Health and Human Services Agency as well.

We have trauma informed care and mental health screening in juvenile hall and therefore full clinical assessments. We now have a trauma responsive unit in juvenile hall with treatment intervention with over 1000 officers who have taken this mandatory training already. For the first time, the funds from the Probation Department partnered with the Public Health and Human Services County Mental Health funds to produce this conference.

Our schools have started 8 years ago with the help of Councilwoman, Marty Emerald to educate their staff. The task force at the Family Justice Center working with battered women (and men) (another first in the nation) has helped educate policy makers and thus instigate this healing in the community. There is much hope…its just very slow.

This was the question each person who attended this conference was faced with. It’s like the starfish on the beach story. “Why, with so many starfish, are you bothering to still throw one back into the ocean?” “ It makes a difference to this one starfish” is the answer.

Unknowingly, uneducated professionals continue enabling their patients. To point this out, even carefully, is considered disrespectful at best, outright arrogant and libel at worse. It doesn’t seem to be any better with licensed professionals such as LCSW’s, LMFT’s, PHD’s or mental health professionals. Addiction education is a very brief course in school. Very few professionals remember or use this education in their careers.

Most treatment centers and hospitals do not do follow up on their patients after treatment for more than 2 years. There is little or no aftercare for substantial periods of time. How do they know which programs truly work for lasting recovery? The dismal success rate of continued recovery would most likely ensure that no one would want himself, herself or a family member to be admitted to that hospital or rehab program. So why follow up or even see what was working and what wasn’t? Even respected research statistics have been doctored or omitted in this country to support certain views.

Things are re-cycled. With what we used to call Schick-Schadel Aversive Conditioning, we are still trying to re-package the same thing and getting the same results.

I worked in the first controlled drinking experiments as a student at the University of New Mexico. We claimed a 90% success rate and actually followed up for two years for the research study. The problem with our results is that we were following early stage alcoholics. Years later most participants relapsed into heavy drinking and some died. We didn’t know what we were doing. We thought we could teach controlled drinking. It was innocent enough. It just led to an incredible number of deaths.
There is a field of thought that touts “Harm reduction”. “Harm reduction” is someone’s fancy word for declaring that in his or her expert opinion you are hopeless. So they decide that it is easier to give you a drug that is more socially acceptable and actually teach you to use more acceptable drugs like marijuana instead of heroin.
Practitioners are actually giving methadone to heroin addicts. They are ignoring the fact that the drug is aging the bones and the body. They argue that their patients are not getting “high” so it is better for society to do this so they won’t be stealing for their drugs.
Always there is a newer, easier, different and “better way”.

History is doomed to repeat itself if it is not examined!!!

Churches are attempting to help their parishioners with “Celebrate Recovery” or “Overcomers Anonymous”. The problem with these programs is that the people are not mainstreamed back into 12- Step programs or given proper education. Despite my education to the church based groups in the 90’s, the request to mainstream the members eventually back into the 12 step groups was not listened to. They put every kind of addiction into the groups and expect it would work. No long -term recovery or diversity of experience in these groups but a lot of religious tenets, which complicate the problem with the non-educated pastors and clergy. It has been frustrating trying to work with that part of the population. You are deemed “suspicious” if you don’t hold the exact same beliefs that that religion espouses. Psychiatrists and therapists, who have been educated at a school that has a similar religious base, will support these programs, without ever having been to them or examining them, leading to a huge disservice to their clients.

Ironically, Bill W. and Dr. Bob, the founders of Alcoholics Anonymous, experienced these same problems with the Oxford Group. History is repeating itself. Unfortunately, it is on a much larger scale. Luckily, Dr. Bob and Bill branched off to form their own group of Alcoholics Anonymous with the traditions to help people not make the same mistakes. Most professionals have no understanding of that program. They have a limited and biased view of the steps and don’t understand the power of the traditions. Yet, in time, it is the only program that doesn’t depend on funds from an outside source and has just celebrated 80 years of recovery. Before that time, there was never anything even close to helping such an isolated and hopeless people as alcoholics.

Most professionals don’t know that the Big Book was written with people who themselves had little more than 2 years of recovery. By that time period and those standards, this was a true miracle. It was the longest time imaginable for hopeless, late stage drunks to have recovered. How quickly we forget if it isn’t passed on.

The doctors and nuns that were part of that movement to treat alcoholics paid dearly and broke many rules to help alcoholics. Somehow, that knowledge and experience wasn’t passed on either. It is documented in the Big Book of Alcoholics Anonymous, but what professional has actually read it as part of his studies?

Psychiatric diagnoses are extremely difficult with an addicted patient. There is a great lack of psychiatric care given to people after getting clean. It’s almost unheard of. If it does happen, receiving treatment without re-addicting the patient is always a challenge. Half of the people coming out of treatment aren’t getting the proper education. Families are rarely involved and remain uneducated. These deficiencies set the stage for an inevitable failure. People who are in treatment don’t remember most of what they were taught because of the condition of their brains and memory. The families who could actually help aren’t being educated and so enable the behaviors that they don’t understand.

I have professionals who actually think that psychological testing is legitimate if someone is on chemicals. They evidently never heard, as I did once in my psych tests and measurements class, that the testing is no longer valid if they are within 3 to 6 months of using chemicals. But, it goes on. People are being treated for the wrong things. Klonipin, sleeping pills like Restoril, Ativan, Xanax, Valium and pain medications of all kinds are being given to patients by doctors and psychiatrists, whose body is constitutionally different as the result of their alcoholism or addiction. Despite the specialty of Addictionology, at least in California, it isn’t an easy to find a specialist. Their diagnosis makes no difference to the surgeons or anesthesiologists who give out the same types of treatment.

I have seen the most grave errors made by professionals and psychiatrists, not only with patients who suffer from the disease of alcoholism, but also have a dual diagnosis such as depression or Bi-Polar disorder. “You don’t really want to kill yourself…you have a young daughter to live for”…or “This will not cause the problems you claim because you need this type of medication”.
I have seen many of my recovering friends, highly intelligent people, who because of the VA treatment, and subsequent ignorance, were given addicting psychiatric medications, only to relapse and end up in prison as the result of their following doctor’s orders. The patient’s arrogance was that “alcohol was my problem” not pills. And so it goes on and on.

I had an “addiction specialist” who had just gotten out of school as a psychiatrist in Beverly Hills treat one of my young patients. They were a progressive group who specialized in addiction. I had picked her as one of the handful of people who would be “understanding” of what I had done with this family. I had followed the daughter and her mother for 10 years. Not only did this doctor not understand what I was doing, but also to my horror, she chastised me for working with both mother and daughter. In doing so, she also by herself, decided to tell the daughter and the mother that they should be having separate therapists. Contracting didn’t work in her professional (and inexperienced) opinion. She wrote to me via email that she had made the referrals out to other therapists as part of her professional evaluation and decision (of 1 month) and hoped that I wouldn’t be offended. The arrogance and the lack of experience were so blinding but where was I to go? My patients, luckily both decided to write her a letter and thank her, but move on to another psychiatrist. (This was by the way, to the tune of the most expensive hourly rate in the country and out of pocket (no insurance) to my patients).

The mother was a physician herself and very experienced with speaking and dealing with systems. The kinds of ways she was mistreated in trying to get help for her daughter, even a hospital rehab, was unbelievable to me. The miscommunication with the insurance, and the obstacles were incredibly discouraging as I tried to help her with her daughter. By the time it was resolved, the desire to get treatment, that window of opportunity by her daughter, had expired. It was an entirely eye opening experience for me.

The tsunami of families affected by mood disorders and addictions have multiplied exponentially since I began in this field. Yet, treatment has diminished. We have people clamoring for help from professionals doing their best to treat what they don’t understand. The saddest thing is that there are definitely answers. There needs to be real education that lasts more than 15 minutes.

By adding the issue of pain to the formula, it is an extremely difficult education for those that come to me wanting to be clean but not wanting to be in pain. There is a way. It isn’t fast and it isn’t quick. In this world with drive through foods, it’s convenient, but we have learned it isn’t always the healthiest decision. The same holds true when we deal with pain issues overlaying the addiction and mood disorder issues. The good news is that there are combinations of medications and treatments that can heal recovering people. There does exist treatment that can help the family understand and help the addict. The family’s pain can be treated and diminished as well. They are surely in as much pain as their suffering loved ones.

I have clients and their families who have been MIS-diagnosed and MIS-treated for over 30 years. When they get the proper treatment for their illnesses, their suffering and stories are starting to be told. They are living examples that there is hope. They are starting to speak out.

I have patients who, as children, didn’t know they were suffering from Bi-Polar or Clinical Depression. It was rare in earlier days to know of such things, much less talk about them. We didn’t know much about mental illness. Today we understand the medical causes of mental disorders. This information missing is the effects on family and the patients themselves. Adults who for years believed they were disorganized or stupid or slow, are now re-discovering who they really are (with medication for a short period of time). They are discovering that there is a name for what they were suffering from. They were self- medicating that pain with alcohol and drugs. When you name it, you gain power over it.

Maybe the trauma of what happened when they were growing up caused the need for self -medication. Simply not using the chemicals is not enough. Trauma sufferers need to be re-parented, re-educated and held accountable for their self-care. Most people have no clue what self-care is. If you think what you have experienced is “normal,” how are you to discover that it isn’t normal? If you have nothing to compare it to, then how can you actually experience a safe group of people to grow up with? How do you know what you are doing may not be right? What are the alternatives? Books and the Internet are wonderful resources, but there is no substitute for people helping people: people who have recovered themselves, and are thriving. They are happy, joyous and free from the same afflictions. How do you teach people how to live life?

You need some set of rules or guidelines. The ones you grew up with may have been inadequate or misguided. How do you get these new guidelines without shame, blame or judgment? How can you learn it is possible to be happy, joyous and free without being airy-fairy delusional? How can you be helped to deal with life on life’s terms? How can you learn to deal with people, all people, with harmony, kindness and compassion?

People that have experienced the pain and come out the other side are the best teachers. Maybe when you recover you will be motivated to help others lessen their suffering. These axioms may have come from such experiences: “We teach most what we need to learn.” “Pain is the touchstone of all spiritual development.” “You can’t keep it unless you give it away.”

Professionals treating those that suffer often learn from their patient’s journey of recovery. They learn not by the book, from the pharmaceutical companies, their peers, instructors or Conventions.

I have devised the programs because intervention as it was originally intended, is still an effective method to help families. The knowledge of medicine, addiction and families that I have learned has taught me that this method must be passed on. Intervention is best passed on by the families themselves, not by the “professional” as some popular shows have proclaimed.

Professionals need to be taught in order to effectively treat their patients and families. They will usually only spend time if it is for their patients. They don’t have time to learn otherwise. They suffer as well if they are not involved in the treatment or education. Most enter the psychology field because of an unconscious need to heal their own issues. It is dangerous if professionals believe they are above the malady that they treat. Treating professionals may alter the rules for their own behavior and so alter them for their patients.

Here are some uneducated, damaging sayings my clients have told me they have heard from healthcare professionals:

• “I certainly don’t think O’Doul’s is a problem for an alcoholic…there isn’t enough alcohol in it.”
• “Well, one drink is good for the digestion.”
• “A little alcohol isn’t the same as a bottle of vodka.”
• “Drinking near beer doesn’t mean that a person has relapsed or will relapse”
• “One Ativan or Xanax is important when it relates to a serious anxiety issue. After all, it’s only once in a while.”
• “It’s important to get a good night’s sleep so a sleeping pill is acceptable once in a while.”

Sometimes when I confront these same professionals about their lack of knowledge I hear:

• “Well, my unique way of doing things has been developed and is so successful that I can help everyone, even alcoholics.”
• “I intuitively know if they are lying.“
• “We have a great rapport.”
• “You are not up on the latest method, technique and are “old school. This new method has great success and you have an antiquated way of looking at things. After all, not all people are addicted or depressed.”
• “Requesting people to not ingest any chemicals during therapy would be ridiculous. Who would you end up treating?”
• “So what, alcohol doesn’t really interfere with feelings. I mean a glass a day. You’d end up with deprivation and that would cause a serious rebellion. It’s not worth it!!!
• “You’d end up with no patients.”

My absolute favorites when confronting professionals are:

• “It’s not my problem. I don’t work on anything that the client doesn’t bring up.”
• “I believe that the client has the answers, so this doesn’t work with my philosophical orientation.”
• “My hands are tied. The wife doesn’t want me to mention his habit of a bottle of vodka per day. She is afraid to get into trouble with him.”
• “I can’t do anything about this if I don’t ask. I don’t want to open a can of worms. I’m not a social worker, I’m a doctor.”
• “CPS would have to be called and this would cause all kinds of problems…. You know what they can do and don’t do.”
• “There may be suspected domestic violence but this client is a professional (teacher, lawyer, doctor, etc.) and capable of figuring it out on their own.”
• “They wouldn’t trust me if I discussed this with them, they would be offended and never come back”

It is the easier softer way to put your head in the sand and not want to see. This is why Denial, Minimizing and Rationalizing for the professional are as easy as for the family or the patient.

What I have determined is the best teacher is “by example”. This is what Dr. Bob and Bill W said in the book Alcoholics Anonymous: “You may be the only Big Book anyone will read. So you must lead by example”.

I have tried several various methods to try and do something different. In the past, I have tried to educate by exchanging professional articles. This works over time, if they are open and willing. Nowadays, who has time to read someone else’s articles, much less what you already have to read?

I have tried to educate politely and directly. I was met with defiant resistance and given an inventory of all the things I had done wrong in their estimation as retaliation. I have tried to discuss why I believed as I did that the medication was not correct or inadequate only to be met with resistance.

The same problem I had when I was the nurse in the hospital. At times, I have shared my own story at lunch, which is met with a better outcome (but who has time to meet for lunch these days). I have also attempted to write letters to the doctors (by snail mail) only to be met with no response or minimal response thanking me politely for the information.

Their response to was, “I am the doctor and this is what the DSM 5 diagnostic manual says.”. Again another young psychiatrist who had told me if I referred my patients to her, she would be happy to learn about addiction. I referred a few clients and suddenly didn’t have time or interest in my suggestions. In fact, she was aided by another young LMFT, who told her that she didn’t believe my client was an alcoholic either.

It was later that I was forced to show my client the psychiatrist’s website. It said she doesn’t treat addiction because this specialty requires special education yet, she was obstructing and causing problems with the medicine she decided to give him, ignoring my concerns. When he finally went to a more seasoned psychiatrist who understands addiction at my urging, his anti-depressant medication dose was raised. Finally, and suddenly after suffering for 2 years from urges to drink while staying sober, they suddenly went away. (A therapeutic level of the anti-depressant med was all it took). Yet, she said that by her standards, he wasn’t alcoholic. She was aided by another member of my profession, who colluded with her. What was obvious to me was this client’s urges to drink for over 2 years. How could she have not seen this? Her “book” and the formula were not in there. She didn’t need to look further. Is everything in this sacred book? Of course not!!! This seems to be an issue not only with the pecking order in the medical profession of perceived value, but in their ability to actually see and hear their patient’s complaints.

I had a patient and her family who was told to find another therapist because I was obviously incompetent. I referred my patient to this psychiatrist in hopes that because she belonged to an exclusive addiction group of psychiatrists that she would get better treatment in Beverly Hills.

My patient was told, amazingly, that I couldn’t treat members of the same family. (I guess she never heard of a family therapist).

In addition, although I had worked with this family for 10 years, in 2 months, she assessed the situation and referred them to another therapist. Besides, she told me that contracts don’t work with addicts. If I had a real bond, my client would tell me the truth about her drinking and using. And since she didn’t take insurance, my clients were paying an extreme amount for her “expertise”. She ended with an email, after the fact, that she hoped my feelings wouldn’t be hurt. Where was professional courtesy or even professionalism?

She ignored the fact that I had worked in this field for 30 years and she was out of school for 5 years maybe. She failed to learn from someone who could have helped her. Her arrogance and lack of humility also cost this family a great deal. Luckily one of the members of this family knew that what she was hearing was wrong. Because my client was a medical doctor and had been working with me for 12 years, she was extremely competent even under stress. She wrote this psychiatrist a letter ending the relationship, which included other examples of this woman’s incompetence with the psychiatric medications. After talking to my California Association lawyer, I could have sued, as could have this family, but what good would that have done? I’ve decided to write about it instead.

As much as I didn’t want to work in this field, as I got older, because of the pain associated with it, I always ended up back here again.

I was overwhelmed by how it seems to have gotten worse, not better.

I have wanted to change professions many times to be able to do things differently. I always end up back here again. I seemed to have been thwarted by a Higher Force that has continued to shape my life.

But then I always remember the works of my early Alanon nurse sponsor told me in the face of unfair and seemingly endless retaliation for what I felt was right. “Do the footwork. The outcome isn’t your business. Stay on your own side of the street. Let God do the rest because the rest isn’t your business.”

I am entering into the twilight years of my profession and light. I believe I have a legacy that must be passed on. I must convey what I have learned and know, by sharing my years of experience with my patients, clients and their families. This is my business and my footwork. What other people think of me is none of my business. The outcome is not my business. What other people think of me is not my business. By sharing my history, experiences and insights, I will have done my footwork. I can rest knowing that the rest is none of my business. It is entirely God’s business.