Rehab

There was an interesting article on the CNN website that lamented that Lohan and Spears were making a "mockery" of the entire rehab process.

Did it really take a strung out actress and a singer past her prime to do that?

Not that I feel bad for them, but really - how much of this is the fact that two good-looking girls are going all out and crazy as opposed to two guys?

There is hardly a tree in the New York suburb of Suffolk that has not been crashed into by a car owned by Bily Joel. And hardly a drug that Robert Downing Jr. has not used to excess.

I wonder about rehab. Does it really work? Are there studies out there that allow us to examine the efficacy and effectiveness of the most commonly used procedures in drug and alcohol treatment? Alcoholics Anonymous does not allow for independent research to examine these aspects of their treatment.

Furthermore, any individual who does question AA is often sent for re-training (at least here in New York). These re-training sessions are similar to the re-education camps that Mao Zedong sent those who opposed the Communist party.

At its core, rehab attempts to stop behaviors, and gives very few skills to replace behaviors. I mean, seriously, does playing squash really take the place of a good drink? (see the ads of TV and in our schools: "Do sports, don't drink").

Rehab is in essence a bunch of DRA procedures- a differential reinforcement of alternative behaviors. People are reinforced for playing ping pong as opposed to drinking or smoking pot.

The problem is that you can do both at the same time. Hey - just look at Sunday softball games - they are designed so you can drink and play at the same time. And Keith Hernandez, legendary baseball player of the 80's used to pop into the dugout between innings to down a cold and snort a line or two.

The issue which people in the rehab treatment community don't really get is that there is really nothing out there which is as reinforcing as drugs or alcohol. There is nothing really that can replace it.

Maybe it might be better to help these people change their environment, permanently. Rehab is a place that these people use which (to borrow a word from the field) "enables" these people. It changes their environment temporarily, allows people to feel falsely secure in this new environment, and discourages people from actually making changes.

It does, however, allow these people to talk about the changes that they want to make. But talking isnt doing.

So, when we blame Brittney Spears or Lindsay Lohan for "making a mockery" of rehab, consider that maybe the intervention of rehab is flawed. Where is the evidence?

Suicides in New Orleans

This is a reprinting of a posting to a blog that I used to manage.

I worked for about 10 years in Nassau county, which is a suburb of New York. The last three years I coordinated a program for high functioning middle school students diagnosed with autism (I'm long since gone).

One of the things that focused on teaching was Theory of Mind, a complex skill that requires individuals to put themselves in other people's shoes, to think their thoughts - in essence, to feel their emotions, to be happy when they are happy and to cry when they are sad. I was rarely successful. Jack was not a success story for me. Sure he had develops some friendships while I was there, but he had not fully mastered the idea of Theory of Mind. But I enjoyed him immensely, despite his resistance to schoolwork and his chronic narcolepsy.

When I went back to visit him in 2005 and the others, he asked me to play chess, his favorite game. We sat there, enjoying each other's silence as the cool September breeze blew over us through the corner window.

"So, did you watch CNN at all?", he broke the silence.

"Yep"

"That's really a shame about those people in New Orleans."

My interest was piqued. "Yes it is-"

"I mean, when the waters are drained those people are gonna go back to destroyed houses, and wow - they might get depression or something bad- or even worse they might kill themselves"

"Why would they kill themselves?"

"WHY?! WHY?! - you're the psychologist - you tell me - they're gonna go home and nothing is there - if that happened to me - I have no idea how I would cope with it. Just no idea. Those poor people."
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So if a child with autism could predict massive depression and suicides, why can't the Federal government, FEMA, the President, the governor of Louisiana or the mayor of New Orleanse predict it? Why couldn't they preliminarily deal with it?

The New York Times reported about a month ago that the suicide rate in New Orleans has risen to at least two times more than the average national rate. Many people who live though natural or wartime disasters tend to develop a disorder named Post Traumatic Stress Disorder or PTSD.

Common characteristics of the disorder include reliving the traumatic event through frightening memories, or nightmares that provoke the same feelings of horror, helplessness, and fear that you felt at the time of the event. These memories can be triggered by exposure to reminders of the event. Of course, the people who returned to their devastated, destroyed, demolished homes were forced to confront and relive the disaster over and over again.

PTSD is a type of anxiety disorder. Researchers from the University of Winnipeg in Manitoba, Canada found that the presence of an anxiety disorder as well as intense levels of hopelessness and despair increased the probability that an individual would commit suicide. It doesn't take a Ph.D. in psychology to know that hopelessness and continued exposure to a stressful event could lead to suicide. It also doesn't take an advanced to degree or a heightened level of civic-mindedness that something can be done to deal with this situation.

The science of prevention is a burgeoning field in psychology, which is guided by a principle borrowed from medicine. Prevention science has led to mandatory inoculations of children to fluoride in water. People who exercise more are less likely to get sick; some managed health care companies now fully or partially subsidize gym memberships. The same goes for psychology as well. Instead of attempting to heal once the damage has been done, we can either:

• prevent the problem altogether
• innoculate the individual so that the problem is not that bad.

Of course, if you have seen the examples I listed above, many of the prevention programs need to come from governmental agencies or need to be instituted by various corporate organizations. It would do no good if two or three socially conscious doctors began to dump fluoride into our reservoirs - we need the federal government to enact this into legislation.

While the entire population of New Orleans required some form of "inoculation" before re-entering the city (as well as ongoing interventions after entering the city), there are certain people who are more at risk for developing PTSD and then evidencing suicidality. Women are more likely to develop PTSD than men; minorities who come from a lower socioeconomic level are also more likely to develop PTSD. Then again, males tend to complete suicides more frequently than females, due to access to more lethal and more severe methods (e.g., guns).

While many people were ready to blame FEMA for the debacle in initial assistance to the residents of New Orleans, they were really not to blame. FEMA is an agency that deals with more long term, protracted issues. FEMA is responsible for initiating and maintaining rescue operations as well as clean-up and rebuilding. FEMA should also be responsible for initiating a suicide and PTSD prevention program for the city; this is FEMA's and the Federal government's most flagrant abuse in this whole matter so far.