ADDICTION ELITISM

An elegant looking, well-dressed woman in a designer suit and handbag that cost more than most people's weekly salary, came to see me the other day. She wanted to 'interview' me to see if the treatment my staff and I could provide for her young daughter was up to speed. Her husband had already called and asked about our credentials, years of experience and schools. So this was the in-person visit.

Her daughter was not present. She was at home where she stayed while in the midst of a Percocet-heroin run. Her mother proceeded to tell me that the 17-year old was not like those 'other people' who came to us for treatment. She was not 'that kind of person'; she was from a 'good' home. And could we treat the daughter at home so that she did not have to come in contact with any of the types the mother had seen in our waiting room.

It takes a lot of restraint not to say what is close to the tip of my tongue when folks take such an elitist stance about addiction and treatment. It is an equal opportunity disorder. Addiction knows nothing about socio-economics, or skin color or age. Treatment is not dependent upon the price of a designer bag or the education level of the parents. It is a condition. It can happen to anyone. It is treatable.

As for the therapy most of us in this profession provide, it is not dependent upon the patient's income. It is dependent upon the patient's needs. We work hard regardless of who the patient is or where they come from in an effort to promote wellness - it's that simple.

OVERDOSE PREVENTION

Of course we all know that the best way to prevent drug overdose is not to take any illicit drugs or medications that do not belong to us. Yet each day young people die needlessly by taking large quantities of Opioids such as Percocet, Vicoden, and Heroin. Their friends see that the overdose results in respiratory distress and they become frightened. They either leave the struggling friend or they dump them outside an emergency room door.

But time is crucial when it comes to saving someone who has taken too many drugs or has abused someone's prescription medication. When the respiratory system is depressed by too many opioids the person gasps for air. It does not take too long for death to come.

But there is a substance - Naloxone(Narcan) that average people can be trained to administer that will save lives. Naloxone reverses respiratory failure in seconds. In a study in California where a survey of 48 communities who are trained to use NALOXONE responded, there were 10,171 persons saved with NALOXONE.

Rather than opposing methods of harm reduction in favor of strict abstinence, I encourage communities to seek out hospitals and clinics who are willing to train and give access to Naloxone in an effort to reduce deaths by opioid overdose.

Medication vs. Drugs

I suppose we could pass it off to vernacular speech when we talk about 'drug addiction', but the truth is that using appropriate nomenclature is important when defining the national epidemic in the United States. IT IS PRESCRIPTION ABUSE.

Drugs are illicit substances that people buy on the street or trade. Heroin falls into that category and in most states so does marijuana. The illicit sale of medications such as Oxycontin, Percoset and Opana falls under the same name- with 'illicit' being the major factor.

Medications on the other hand,are prescribed by a physician or nurse practitioner for a medical or psychological condition. The abuse of these medications is the leading cause of concern in this country. Taken as prescribed, medications mitigate pain, lessen anxiety and lift depression. The problem comes when people share their medications or take them as they feel like it to change their emotional state. I understand the pressure that we are all under- never being able to shut down or turn off (computers on IM at work and at home, cell phones and text in the car and when we walk,shop or work out; and the radio competing with TV and the internet for our attention). Yet self-medicating to deal wit these stressors IS NOT THE ANSWER. IT IS THE PROBLEM!

Whitney Tormented by Drugs

Although we do not have the written autopsy report from the death of Whitney Houston, there is a good chance that we will read that drugs and alcohol were contributors to her passing. Once again, we watch a person with a God-given gift and tremendous talent succumb to drug addiction. This begs the question as to why this happens? Did those around her not want to interfere? Were they so star-struck that they could not take her to a facility where she could get help? Did they think this was a boundary issue and that they should mind their own business?

Whatever, the justifications, the bottom line is we lost a magnificent talent far too soon because no one intervened. In the 1970's Time magazine had a cover page with the question: ARE WE OUR BROTHER'S KEEPER? In a world where opioid dependence and prescription drug abuse is an epidemic, the answer is 'we need to be'. We cannot turn our heads or backs when we see drug abuse. We need to intervene when someone gets behind the wheel after smoking marijuana or drinking alcohol.We have to say 'not in our family' when a teen takes pills that are not prescribed. It is time we take our heads out of the sand and step up to stop addiction before we lose another angelic voice. RIP Whitney.

DISEASE VS DISORDER

I am attending a major 'think tank' session today in Texas. The discussion revoles around whether to subscribe to the new definiton of addiction, set out by the American Society of Addiction Medicine. For Physicians and Pharmacists this is an easy sell. They call it a 'brain disease'. It is chronic and can be treated by medication. But the question still lingers as to why it occurs in the first place. If it is a disease than it just appears - we have no participation in it. If it is a disorder then maybe there is the implication that we have a part in the process. No one sits on our chests, puts a funnel in our mouths and pours alcohol down our throats. Likewise no one forces us to ingest or IV opiates. This 'disease' only shows up after we have participated in an action to make it happen. I would like to suggest that we have a disorder or even an illness, and we need help and support to get well. Wellness is our goal. Whether we use pharmacotherapy, or AA, or Mental Health/Substance Abuse Counseling, the goal is the same and we must be involved in the process somehow. Although ASAM decided to redefine addiction in a way that benefits physician practices and pharmaceutical companies, we must consider that stepping up on our own is a critical part of personal wellness.

Recovery is a Life-long Endeavor

Many people think a person in recovery needs to relapse to understand the numerous issues surrounding the addiction process. Those of us who have been in the field for a while realize that most folks relapse - not because it is a necessary step in the process, but more so because a person gets stuck in some phase of recovery and falls back on what is comfortable or what is known. Recovery is developmental and progressive in nature.

For example:

1. The person needs to gain insight into his/her relationship with a substance or behavior. Most try willpower to stop and when this fails after 6 weeks they get stuck.

2.After some time being abstinent real life problems come alive. There is no chance to self-medicate and the person gets stuck again because they do not have tools necessary to manage their day with its complications.

3. In the early recovery stage we work on issues such as shame and guilt - many hard to handle.

4.Later recovery is when we repair damages. Rejection from others when we expect amends causes either a clash or a sticking point.

5. Maintenance is forever. It is critical to live life, not let boredom set in and think we are 'all better'. Then we regress to our old ways and we are really stuck with trying to put the pieces back together again. Recovery is a living part of life that must be kept healthy, active, nurtured, and sprinkled with daily spirituality if it going to thrive!

2010 TIME TO BEGIN AGAIN

Every New Year’s Eve folks deliberate on resolutions about how they want to live their lives differently. Lose weight, stop smoking, start exercising, go to church, work less, get a job, play more, give up drugs. Statistics report that most of these are broken or forgotten within the first thirty days of the New Year.
So why do we make resolutions? The definition of insanity is repeating the same behavior over and over and expecting a different outcome. Isn’t that what we are doing? We start the New Year behaving insanely and expect the next eleven months to get better. How about a different approach?
If we truly focus on the fact that the whole world is open to us and the only obstacles that keep getting in our way are those we construct ourselves, we could view life with a new perspective. Here are some ideas.

How about waking up each day and being grateful – that you are above ground!

Maybe we could enjoy the food we eat instead of inhaling what is on the plate, to get to dessert.

Instead of complaining about the snow – try playing in it.

Don’t wait to get to church to pray – talk to God in your car while the motor is heating up.

Since anger only grows- replace it with kindness and humor.

Rather than letting one thing ruin the entire day – let it go, and enjoy the next moment that has to be better.

Since yelling at the kids to behave doesn’t work- how about redirecting them to something fun for all of the family to do.

Live as if this is your last day and enjoy every minute of it. There are no tomorrows for parts of the world. There are no second chances for the majority. So if you are given one, hold it tight and use it in a positive way.
If you are not in prison – every day is a holiday. If someone, somewhere cares about you, you have love. If someone gives you a paycheck, you have security. If you can read this article, you have sight and education. And if you can talk about this with anyone at all, you have connectedness with society.

Let’s stop and count the blessings we have this year instead of wasting time trying to redesign our lives with silly resolutions. The whole world is open to us, so we need to begin living in it, in a positive, responsible, grateful way!

Be well, Dr. M