Saturday, May 2, 2015

Amy Andre McNamee, PsyD, on Helping Veterans with Mental Health Problems and Substance Abuse

I always arrive a couple of hours early to our programs to set up the room with the Compass, ND brochures, etc. Imagine my surprise when I saw this Zombie Rescue Truck.

How hilarious! On the other hand, what if it's true that Zombies are invading our land. At least it's not the Body Snatchers.

Image result for body snatchers  The 1956 version w Kevin McCarthy and Dana Wynter, tho the 1993 version with Donald Sutherland was just as good.

Amy Andre McNamee received her PsyD degree from Chestnut Hill College, where she has been teaching for 11 years, in addition to her work at the Philadelphia Veterans Administration.

Chestnut Hill set her up for a year-long internship at the Veterans Administration on Woodland Avenue in Philadelphia.

Image result for phila va hospital
She learned a lot and enjoyed her work. They offered her a job.

She is Assistant Director of the Addictions Recovery Unit and
Program Manager of the Opioid Treatment Program of the Philadelphia VA Medical Center.

In fact, today, was the naming of the medical center to Corporal Michael J. Crescenz Medical Center in Recognition of the Vietnam War Medal of Honor Recipient Michael J. Crescenz.  Read more about this soldier who gave his life for his country. 

DRUG ADDICTIONS

From Wiki - A methadone clinic dispenses methadone (Dolophine), a schedule II opioid analgesic, to those who abuse heroin and other opioids. The focus of these clinics is the elimination or reduction of opioid usage by putting the patient on methadone.

Other drugs used to treat opioid addictions are suboxone and a monthly injection of Vivitrol. 

These drugs will not help those addicted to Xanax or Cocaine.

Where is the purest form of heroin found?

You guessed it. Philadelphia. The heroin is 87 percent pure and it's cheap. $10 per bag. Many people who use it will instantly overdose b/c it's so strong.

Fortunately, there's a Naloxone Rescue Kit, which police and paramedics carry. If you're passed out for a different reason, you won't be hurt by the Naloxone.


Image result for naloxone rescue kit




TREATMENT IS FREE to all veterans. This goes for other conditions as well which may not be combat-related.

There are satellite offices where veterans are also treated. In this area are outpatient clinics in Camden, Gloucester County, NJ, and at the former Willow Grove Navy Base.

B/c there are so many wars going on, we're learning, said Amy, better treatments for physical injuries such as brain trauma. The VA has a program where they hire patients and teach them to work in preparation for work on the outside.

Read my 2013 story on Patch.com where two Iraq and Afghan veterans find work is the best source of healing.

War Veterans' Next Mission: To Install a New Water Main in Upper Moreland Township

I encountered the two vets who were laying new water mains in front of the Upper Moreland Library.

Image result for edith pearlman  My current book.

Sadly, British author Ruth RENdell died today of complications of a stroke. In the kitchen I'm listening to her
Image result for endless tears rendell

An Inspector Wexford novel.

Image result for obama  

President Obama in 2008 said you can receive compensation and a pension if you fought in Vietnam. All you need is your discharge papers. Previously you neede long-winded proof of the places where you fought.

Amy and the other therapists must learn about different military cultures including racial, socioeconomic, and religious.

Most veterans refuse help. They believe that nothing can "break them," said Amy. That they are part of a culture of strength and resilience. Stigma against physical and mental limitations.

Altho the US has been in Afghan and Iraq for more than 10 years, few veterans are coming forward for help. It takes a while. Failed marriages, drinking, drugs, loss of jobs, depression.

In Afghan, people are on "high alert." Constant vigilance. It changes the way the brain works.


PROTECTIVE FACTORS from PTSD and substance abuse

Being married
Being older
You're not an ethnic minority
Good support system
Higher socioeconomic status

FIRST THING is to diagnose the patient. Amy gets an hour to do this. She tells the client she'll be typing her notes on a laptop, but engages in eye contact.

She asks them how they view being a veteran. For some, it's how they identify themselves.

The sad fact is that many veterans believed they had a career in the military. However, when they were injured this dashed their plans. What will they do now? They can no longer continue the tradition of a "military family."

Clients say they want to work on their depression. There are evidence-based treatments that are used. Cognitive behavior therapy and possibly antidepressants. 
Image result for rubik's cubeFinding the right treatment, said Amy, is like putting a Rubik's Cube together.

Client may mention that in Afghan there were IEDs in the road. When they returned home, a plastic bag may be on the side of the road, triggering a thought that it's an IED. The veteran then overreacts in order to get away from the supposed danger.

They also suffer from road rage.

Many veterans have stopped driving entirely.

To enter the military, you cannot be on any medication. It will not be available in war zones.

Today, noted Ada Fleisher, 


the standards to enter the military have been lowered, so that some people with criminal backgrounds are accepted.

MORE ON ADDICTIONS

You must be ready to get rid of your addiction.

Why do people become substance abusers - alcohol or drugs?

Usually a traumatic event as a child or teenager. Sexual abuse, physical or mental abuse. Death of close family member.

These events are discussed.

More common with lower socioeconomic individuals. A lot of them grow up in an atmosphere of abuse and a culture of drug addiction.

Other factors are length of service, are you a volunteer or were you drafted - sent over against your will?

Did you experience racism in the service?

She asks about client's "pre-morbid condition" or your mental / addiction history before you went into the service.

Many in the area were affected by gang violence in the neighborhood.
Image result for north philadelphia gangs

There is finally compensation for those affected - or killed - by Agent Orange. The federal government is still quibbling whether to allow reservists who handled the Agent to receive compensation.

Terrible side effects from Agent Orange.

Across America, there are not a lot of VA Centers.

Image result for va centers map   So tele-therapy is often provided.

Image result for oxycontin Drug OxyContin was originally used to help pain in terminally ill cancer patients. Developed in 1917 in Germany, read more here.

Amy develops various strategies for clients to follow.

Exposure therapy helps those with PTSD, a term that was unknown until the 1980s, though after the first two World Wars it was called "shell-shocked."

The traumatized individual repeats the tale of his trauma to the therapist. It is not done in a group as it may trigger another member to remember something terrible.

You repeat your tale over and over and assign it a number from 1 to 100.

It's very difficult to do, but the fact that Amy or another therapist is listening to you makes it easier.

EMDR is not used. It doesn't work.

Clients are also taught to re-socialize. Once a soldier is removed from the war environment he must learn how to live a so-called normal life, which is now quite foreign to him or her.

The clients talk with one another, play games and cards and might take an excursion to the Art Museum.



There are also chaplains on hand for spiritual guidance.

Image result for charlie chaplin   

As you can see, many approaches are used to help the veterans. Couples therapy is used.

When Amy began working at the VA there were only 20 psychologists.

Due to Congressional orders in 2012 and 2014 the number shot up for 40, which is still not enough.

One success story Amy mentioned was a Viet Nam vet who couldn't sleep through the night as he had nightmares.

You can't see what's happening in the dark, so he slept fitfully for one or two hours at a time. He could sleep during the day.

His problem subsided when they did "imagery rehearsal" which is considered a type of cognitive behavior therapy.

We asked Amy how she processes her emotions before she goes home to be with her husband and 5-month-old Kiernan, a son.

One thing she does not do is watch war movies like An American Sniper. Neither do her colleagues.

She has supervision, she said, where she talks to an advisor about her clients. This is very important. She also has many healthy interests. She exercises and she loves to cook.

Every day she walks into the VA is a chance to help a veteran live a better life.

Image result for mandala buddhist  As a gift, we gave her a Buddhist mandala, as suggested by Brett.

Hey, said Rich Fleisher. My mother/law got one of these in the mail.

That's because Lillian Moss is on my Postcard List.

When I was doling out the Mandala postcards I sent one to a surprise guest.
Image result for sharon piercy


My Three Poems for Huntingdon Valley Library Poetry Night - Altered State - Evergreen Shampoo - Lawn Party





ALTERED STATE

Me, one of the millions
who have diabetes. Not grossly
overweight, not a junk food
addict, my antirejection
meds gave me the disease.

Diabetes rules my life, I told
my sister, who can eat anything
she likes, grilled cheese
sandwiches on rye and Archway
cookies straight from the box.

She has no idea what happens
to me in the dead of night
when I awake and am “low.”

The “low” killed Bobby’s roommate
found face-down on the floor,
a promising pharmacist, like Bobby
himself.

With the purple light of dawn
filtering through my drapes
I arise like Lazarus from what
might be my tomb, pause a
moment, and close my eyes.

Something is wrong.
Very very wrong.
Aha! I am low and bound
down the stairs in my
pre-owned striped pajamas
that make me feel like George
Elliot. If only I could wear them
to the Vietnamese restaurant.

Switching on the kitchen light
the room vibrates
boink boink boink!
as I reach for the foods
that will save me.
I rip open a new bag of
pretzels, flood them into
my mouth, then get some
chocolate raspberry yogurt
from the fridge, dripping it
onto my PJs.

My sugar level is 35. Normal
is 80 to 120. I step onto
the front porch in my pink
diabetes socks, then run
down the sidewalk to
look up at the stars.

Jupiter, I wave, with its
many moons. I am
saved. I am saved.

Lying in bed, body
heaving, I think
this must be like
taking drugs. Cocaine
where they
get the bloody noses.
Hands on chest, I am
rocked to sleep by
Charlie Rose humming
in the distance. 

***
Hurry Perseus, I'm frightened!

EVERGREEN SHAMPOO

The tiny transparent bottle I stole
from LaQuinta Hotel in
New Orleans, resembles a
lipstick container or
a coffin. I husband the
remaining sweet-smelling
drops I rub through my
silver hair, never believing
I would get this old. Rubbing
my skull, I remember my
week in The Big Easy. As long
as I have the shampoo, I will
still be in New Orleans.

Ever eaten Shrimp Po-Boys
at the Commerce Deli? Bread
that crackled like a mouthful
of diamonds, and succulent
shrimp who gave their lives
for us.

Most of all I’ll remember the
bus ride. Legs
dangling as helplessly as
Andromeda tied to
the rock. Where was Perseus?

The god was in my suite
on the fifth floor.
Listening to the patter
of the rain on the roof,
I massaged my ankles,
swollen as the Crawfish
Sandwich I ate at the
park, staring at
St. Patrick’s Cathedral,
and wishing I could
ask Jesus for help.

***

Image result for queen elizabeth



 
LAWN PARTY

The Queen of England
dressed in yellow, is
hosting a lawn party
and so shall I.

Please be my guest.

Out come the picnic tables
spread with tiny cucumber
sandwiches, on whole wheat
toast. The lone maple tree
nods in approval.

What’s a spring party
without lemonade? I’ll
serve it in my pink pitcher
Mom gave me, though at
ninety-two she would
no longer remember.

You’ll meet my mom
along with a dozen guests.
Beethoven will be there
with his wild eyes and
white poodle hair. A silver
ear trumpet will rest on
his table. I do hope he likes coffee,
the Vanilla-Hazelnut
I drank earlier today.

I’ve always admired the
poet Rilke. He’ll sit over
by the forsythia bush,
spiking toward the sky.

I’ll only invite one dead
boyfriend. Not Simon
The Hoarder, but
Christopher. He’ll drive up
in his Mazda truck, brimming
with laughter in his plaid shirt
and faded blue jeans.

You thought I’d forgotten you,
I’ll say, though you left me for
another.

I’ll stand atop a table and
recite through a megaphone:
We’re having a party of the world.
And the bluejays and cardinals, the
tiny little sparrows, will twitter
in approval as they
soar across the yard,
pooping as they go.