Michigan Teenagers who drink can sometimes find themselves on the wrong side of the law.  This includes being charged with crimes like MIP (minor in possession) and Minor BAC (which is under age drunk driving , also known as zero tolerance), among others.

Many courts in Michigan treat underage drinking very seriously.  Some judges have a track record that includes jail time for crimes involving underage drinking, but most judges understand that severe punishment for these kinds of crimes is not appropriate.  Instead, many courts look at teenage drinking crimes as an opportunity to assess whether or not the teenage offender is at risk for problematic drinking, and then to order that the offender become involved in treatment.  To assure compliance, the court will also order monitoring like daily or random PBTs (preliminary breath tests).

In order to be proactive, and to help the teenage offender and his/her family determine if an alcohol problem does exist, or might be brewing, some lawyers in Michigan will refer their client for a private substance abuse evaluation.  This substance abuse evaluation can be used as a baseline to begin treatment, and it can also be used by the lawyer to help with plea negotiations and sentencing.

Substance abuse evaluations for crimes like MIP and Minor BAC as the same as substance abuse evaluations for “adult” crimes like drunk driving.   As such, the substance abuse evaluation will include an interview and the administration of usually two or three different psychometric tests, the purpose of which is to help the therapist determine if there is a drug or alcohol abuse problem, and then to recommend an appropriate treatment plan.

The evaluator, usually a clinical psychologist or other highly trained mental health/substance abuse professional, will determine from both the tests administered and the interview if the patient meets the criteria for the DMSV 5 diagnosis of an alcohol use disorder.  This diagnosis is one of the factors used in determining the treatment plan with the client. Oftentimes clients will follow up for treatment by using their health insurance plan; however, evaluations that are legal in nature are not covered by health insurance policies. The treatment portion of the evaluation, if recommended, is covered as long as it has not been ordered by the courts. This is another reason for a youth to be evaluated prior to sentencing in the courts. Besides the financial and legal incentive for an independent substance abuse evaluation, the client benefits from early intervention by an evaluator in order to receive guidance and direction toward a healthy relationship with alcohol in the future.

Many times youth will not in need of follow-up treatment, and the evaluation can assist the lawyer in the advocacy of the client in terms of suggesting a lighter sentence. However, when treatment is warranted, early intervention not only assists the youth’s developmental trajectory and well-being, but assists in the planning purposes and shows prior cooperation on the part of the youth at sentencing time.

 


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Dr. Charles R. Schuster came to Wayne State University School of Medicine in 1995 to take responsibility for forming a substance abuse research center. He had recently left his position as Director of the National Institute for Drug Abuse, National Institute for Health (NIH) where he had served for the prior 8 years under then President Clinton.

While at WSU Dr. Schuster was very successful in establishing a unit that specialized in human drug abuse research that also provided excellent clinical care.  Dr. Elizabeth Corby began her post-doctoral work under mentors Dr. Schuster and his wife Dr. Chris-Ellyn Johanson in 1996 at the clinical research division on substance abuse.

In 1997, Dr. Corby became an assistant professor in the Department of Psychiatry and Behavioral Neuroscience, where she continued to work with Dr. Schuster until 2000 when she left to become a senior staff psychologist at Henry Ford Hospital’s chemical dependency treatment program, Maplegrove center.

According to Dr. Schuster’s obituary:

“By the time Dr. Schuster came to WSU he had already built up an impressive resume of accomplishments in the research and treatment of addition, particularly related to opioid addiction. The university offered him an opportunity to work with addict patients. Bob developed a strong research group embracing pharmacology, psychology and psychiatry with collaborative relations with a number of colleagues in these disciplines.”

Dr. Corby feels very fortunate to have spent part of her career working with Drs. Schuster and Johanson, and has many fond memories of their work together. Dr. Schuster was a giant on whose shoulders many of us stand, and he will be deeply missed.


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 A promising new type of cognitive therapy called “brain training” has been demonstrated to be useful in treating drug addiction, according to an article recently published in the recent issue of Biological Psychiatry:

Warren K. Bickel, Richard Yi, Reid D. Landes, Paul F. Hill, Carole Baxter. Remember the Future: Working Memory Training Decreases Delay Discounting Among Stimulant Addicts. Biological Psychiatry, 2011; 69 (3).

 I use this type of therapy in my office to treat all types of problems ranging from depression, to AD/HD, to addictive problems. This new study adds significant weight to earlier preliminary results that brain training is highly useful for problematic substance abuse.

We have come to learn that drug addiction leads to changes in the actual structure and function of the brain. People with compulsive addictions, especially those that are substance in nature, tend to exhibit a trait called “delay discounting”, or the tendency to devalue rewards and punishments that occur in the future. People with addictions may at the same time have a predisposition towards what is called “reward myopia” which is the tendency towards the immediate gratification that drugs can provide with addictions.

Warren Bickel, Ph.D., a pioneer in Brain Training and his colleagues at the Center for Addiction Research in Little Rock, Arkansas borrowed a rehabilitation approach used successfully with patients suffering from stroke, or traumatic brain injury. The therapy approach involved stretching general memory capabilities. Subjects addicted to stimulants were given brain exercises that focused on strengthening the areas of the brain associated with storing and managing information reasoning to guide behavior. Dr. Bickel’s team found that by strengthening the brain circuitry, they also reduced the addicts devaluation of longer term rewards.

Dr. John Krystal, Editor of Biological Psychiatry comments on the article:“The legal punishments and medical damages associated with the consumption of drugs of abuse may be meaningless to the addict in the moment when they have to choose whether or not to take their drug. Their mind is filled with the imagination of the pleasure to follow. We now see evidence that this myopic view of immediate pleasures and delayed punishments is not a fixed feature of addiction. Perhaps cognitive training is one tool that clinicians may employ to end the hijacking of imagination by drugs of abuse.”

My experience with Brain Training has been equally exciting, in terms of seeing clients learn to develop competing thoughts and goals that not only challenge their maladaptive patterns (e.g., depression, anxiety, impulse delay with AD/HD or substance abuse), but replace those thoughts with real expectations of rewards in the future, if the client were to change his or her old pattern. This “old versus new” brain idea is explained to clients as offering a choice – either clients can revert to old “reptilian” responses that keep them locked in their psychic pain, or give a good mental workout to new neuroconnections that satisfy and encourage new thought and behavior patterns, and rewards! Putting it another way, if we envision in our minds new positive possibilities, we can not only get excited about those potential outcomes in our lives, but we can actually increase our brain’s likelihood that the brain “muscle” will train and grow in response to our cognitive strengthening exercises. How cool is that! So maximize your “brain
plasticity.” Cognitive Brain Training is an extremely useful addition to another great technique I use, Mindfulness Based Cognitive Therapy (MBCT), which will be the topic of my next blog. Stay tuned.


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My desire to help to treat psychological and addiction problems has been something of a passion of mine for many years. This article linked below was written in 1998 for the Wayne State University School of Medicine newspaper “The Scribe” about a program to treat adolescents with psychological and addiction problems, that I developed and directed while on faculty at WSU. Actually, I have another fond memory that emanates for me from this article, in addition to my work, at WSU. My daughter, with whom I was pregnant in this photo, was born just days after the journalism staff had interviewed me for this article! My commitment  to helping individualize treatment and provide the best possible help for your problems, whether they are psychological or substance related, continues just as strongly today:

http://www.med.wayne.edu/Scribe/scribe97-98/scribes98/adoles_get_dual.htm


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This is a landmark study – a meta-analysis by Dr. Keith Dobson that reported that cognitive therapy was even more effective than medication treatment or other psychological treatments for treating most depression. Medication treatment, however, when added to cognitive therapy with more severe depression, results in the best outcomes:

http://psycnet.apa.org/?fa=main.doiLanding&fuseaction=showUIDAbstract&uid=1989-30221-001


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Once you have made the decision to seek treatment for your psychological and/or addiction concern, the next thing you will need to decide is with whom to treat.  You will also need to make this decision as you look for someone to prepare you substance abuse evaluation for your Michigan Driver License Restoration Hearing.

One thing to consider is the specialized background of your particular therapist.  It is also important for you to have a good professional relationship with the person you choose.

Keep in mind that the area of addiction medicine is very complex and does require specialization.  Also, and I know this is confusing to the public, training levels of professionals vary widely and the term “therapist” tells you very little about the person’s education level.

Master Degree Therapists:

People that have obtained master’s degree level training often call themselves counselors, therapists, psychotherapists, social workers or limited-licensed psychologists.  By Michigan law they may not call themselves “clinical psychologists” because this title is reserved exclusively for PhD level training.

Most master’s degree therapists have anywhere from 1 ½ to 3 years of graduate training after the college degree. You should also be aware that there are health care workers who do not have any or very minimal formal college training who can call themselves counselors.

Clinical Psychologist:

To add to the confusion, there are different kinds of clinical psychologists which depend on the type of specialized training.  Some PhD level psychologists have training that is geared toward research only while others such as myself have PhD training that is geared toward research and treatment.

Typically, clinical psychologists have over 10 years of higher education.  Clinical psychologists must complete a doctoral dissertation or independent full-scale research project as a requirement for the degree. Many clinical psychologists continue research and continue publishing research throughout their careers. At the early part of my career I did research and publishing in the area of cognitive behavioral therapy and addiction and treatment of addiction.  I now devote my practice solely to seeing patients.

After completing their “formal” training, clinical psychologists also must work in the field for one year in internship before being granted the final degree. Then they must pass a grueling state licensing exam which they cannot even take until they have been practicing in the field for two years after receiving their PhDs. In addition, many psychologists like myself, undergo even more training, such as my additional two year post-doctoral fellowship and year-long training for certification in cognitive therapy through the Academy of Cognitive Therapy in Philadelphia.

Finally, once they jump through all these hoops and can finally practice independently (whereas most other counselors, incidentally, can never can practice independently, but must always be supervised), PhDs generally partake in continued education to stay up-to-date on research and techniques to keep them on top of the field.

Because of all this dual training clinical psychologists are true “scientists-practitioners,” and the best always keep their pulse on the cutting edge of biological and psychosocial treatment research, while bringing the developments of science to you in the treatment office. Many clinical psychologists also serve as faculty members at major colleges and universities.

Knowing the background of your evaluator and/or therapist can help you make an informed choice of the best person to meet your needs, and can make a big difference in your treatment outcome.


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