mortiz095

A few months ago, an article in the St. Paul Pioneer Press described a "wet house," where people who were unable to stop drinking were able to get housing and access to services without requiring that they stop drinking. A very typical response, especially from people in 12-step programs and in treatment programs, was that this was "giving up" on these unfortunate individuals, that the proper treatment or 12-step participation would result in their being able to sustain abstinence. A number of people have asked me about this. Here's my response to a recent inquiry. MW I actually did research on this in the late 1980s and got quite deep into what the best approach was for chronic public inebriates. The problem we were trying to address was that these folks would cycle through the detox center over and over. A minority of users accounted for the majority of visits to detox, which is expensive. In addition they are frequent guests in emergency rooms and hospitals. ...

In this new publication, the authors found that both counselor and program characteristics influence counselor attitudes towards use of medications in treating addiction. People who are looking for treatment need to ask about these attitudes prior to agreeing to enter a program or therapeutic relationship. It is a sign of how far the US treatment industry must go when "attitude" determines the treatment you get, rather than evidence based guidelines. And be skeptical when a program or staff member says they use "evidence based practices." Too often, that consists primarily of some training to update counseling skills, but it doesn't involve moving beyond an ideological approach to a scientific one. Consequently, too many treatment staff still see science as useful only insofar as it can validate already held assumptions. We all know, however, that's not how science works. It's designed to upset and surprise because it uses methods to minimize bias. And w...

In this Baltimore Sun article Dr. David Linden of Johns Hopkins University gives an unusually succinct description of the underlying neurobiology of the development of addiction. Note the interplay between genetics and intoxicant exposure: if you're brain isn't genetically vulnerable, you are not likely to become addicted to a particular drug. Note also that this vulnerability is substance-specific, not a generalized "addictive personality." MW Baltimore Sun Johns Hopkins neuroscientist David Linden explains the biology of pleasure With his new book, he seeks to find out why vices -- and even virtues -- can hold such sway over our lives By Mary Carole McCauley, The Baltimore Sun April 14, 2011 Not all addictions live up to their advance press. In the past decade, it's become common to casually and humorously describe a favorite activity in the parlance of chemical dependency. People speak of being "addicted" to chocolate or high-fat foods, playing ...

Most of the patients I treat who have chronic pain are distressed by stigma and the ignorance behind it. They are often judged by relatives, friends, doctors, nurses and others as being weak, addicted, defective, "not tough enough," "not motivated." Worst of all is the epithet: "Drug Seeking." Drug Seeking is a judgment impersonating an objective clinical observation. Drug Seeking implies asking for ("seeking") pain medication for non-legitimate purposes, such as getting high, "being a chemical coper," or other reasons not related to pain control. These judgments are almost always made by people who have never experienced unrelenting severe pain. Pain wears you down. No matter how good you are at coping, it pushes you to the edge. If you have other problems such as chronic physical or mental illnesses, it's just that much harder. The more chronic illnesses you have to manage the harder it is to manage any of them very well. When one...

In this recent article in the Washington Post , the growing use of opioid treatment agreements is examined. Although increasing in popularity and pushed strongly by the government (read: DEA ) these agreements are at best a mixed blessing. This is all part of a growing sense of unease about using opioids in chronic pain, and a move to further restrict access to them. These agreements may do more to protect the prescriber from liability than to protect patients. What is clear to physicians, however, is that there is no liability from refusing to prescribe opioids even if it leads to serious consequences including disability and suicide because patients are held responsible for them. On the other hand, doctors feels the hot breath of the DEA and state medical boards and the threat of malpractice suites very acutely. As with all medications, opioids carry a risk and it is important to minimize it, but even very reasonable risk in the context of substantial benefit is fraught with danger ...