Substance Abuse Update

 Some things never change.

That is a great truth I have discovered. Many things are not what they appear to be and if we don't want to see something we usually won't see it until we choose to. As a behavioralist, one constantly learns just as much about oneself as will be discovered about the subject of therapy or treatment. The accurate diagnosing of a condition improves with repeated exposure to similar cases. Strong intuitive instincts can be quite useful and must never be ignored.

In this life I believe there is a reason for everything that happens. I once believed that God allowed substance abusers to cross paths with me as punishment for some terrible sin I may have committed at some past time. What other explanation could there be? Over time I've grown to learn that many times it's not even remotely about this sick and clueless individual who chooses to slowly poison themself into oblivion and eventual death of the spirit, mind, and body. Reality often turns out to be that I deluded myself into believing it was my purpose to heal them, only to eventually discover that the only help I can dispense is to expose them to the truth about themselves and then remove myself as completely as possible from their life, allowing them to advance or decline to the next stage of their journey.

Substance abusers with narcissistic or antisocial personality disorders can be the coldest people on earth if you aren't aware of whom you are dealing with. I have found them not to be frightening but mostly disappointing, frustrating, and ultimately a proverbial pain in the ass. I say that without malice because they teach me more about my own weaknesses and assets as a person than any other type of patient I have encountered. I have found my greatest liability to be that I have a tendency to be too trusting of others. Addicts over time have developed a predatory nature with a highly keen sense of detecting those who commit to trying to be honest and trusting. They have years of experience practicing on those closest to them and usually find themselves on a perpetual search for another bridge to burn in their quest to relieve their psychic pain. It is crucial that the psychiatrist never forget that everything is a game to these individuals and you to them are just an ace waiting for the opportunity to be played. This ace status is directly related to having control of the prescription pad and in no way suggests superior value as an individual.  Objectivity must be preserved at all costs and one must never allow their ego to enter the treatment arena, for the patient has a great advantage when it comes to emotional manipulation in such a case. It must be remembered that the goal isn't always cure with this type patient. The main goal, once again, is exposure of truth then allowing the chips to fall. I really hate this game but have become much better with it over time.

Experiments with lab mice have been performed where the subjects receive a choice between cocaine or food and water by pressing a lever. Every single mouse hits the cocaine lever until death occurs from starvation and dehydration. The ability to save their own lives is over-ridden by the addiction to the cocaine. Despite a more highly developed brain the outcome for humans with addictions, over the long haul, is similar. The addiction does something to the common sense center of the brain in humans. It never ceases to amaze me how predictable the behavior of an addict actually is. It's almost like a worn out script what they are going to say or do. I must admit that it is more interesting as the doctor/therapist after learning how to see it coming, which it takes a while to do. The true narcissist might actually read this post (some have read my book) and conclude they now know me and would seize the opportunity to use this information to their advantage. To the average reader I know that may sound a bit absurd. I find it absurd for a person to choose a psychiatrist of all doctors to attempt a dupe or scam on. Any fool could get away with it once but who in their right mind would try it repeatedly and not expect to get busted? I then remember that the person has a damaged brain from chemical abuse and think of the rat experiment. The total number of patient dismissals from my practice should reach 200 by the end of the year. We have become much more efficient at identifying those just looking for a way to get high. I find it despicable the lengths people will go to to obtain narcotics.

There is such a thing as a point of no return for an addict. I find the disease to be worse than AIDS and just as bad as cancer. The worst addict doesn't see a serious problem, however. I believe this point of no return is reached when the addict is eventually confronted with the choice of family or drug. If the wrong choice is made at this juncture the ballgame is over for all practical purposes. They may verbalize the choice of family but that is totally worthless if a consistent change in behavior and attitude isn't observed over a sufficient period of time. If the denial and minimizing continues, and there are enough enablers available, there is zero chance for successful recovery. A popular movie line is "never trust a junkie." I wouldn't put it that way but my experience tells me that is probably true. I will still always look for the good in people first with the understanding that we all are as good as the choices we make. When a person is involved in a pattern of persistently making bad choices, sometimes the only thing that can be done is to let them know that you won't be a part of that and do whatever necessary to make that happen. Doing so can save hours of conflict and pain.

Media vs Blogosphere:3rd Anniversary Entry

         

Exactly a month ago marked the third anniversary of this blog.

I'm asking myself tonight why I have maintained this weekly ritual since such compliance in practically all other aspects of my life does not exist. I'm also wondering if I would continue to write so faithfully if no one bothered to read my entries. I think I just love writing and find it to be therapeutic in many ways. I probably would. I believe I have a lot to say but understand how limited the audience reached will be. In many ways psychiatrists are still stereotyped and misunderstood. I'm trying to change that as best I can. My view still remains that the total number of readers is much less important to me than the enthusiasm and degree of interest a potential reader may show. The fact that a reader from thousands of miles away can instantly share my ideas and emotions through the miracle of the Internet continues to amaze and intrigue me. Less than twenty years ago this was unimaginable. This medium has made the world a much smaller place and provides a voice to any individual with access to a PC.

My initial motive for Thoughts From the HEADoc was simply to vent the anger and frustration I felt about some of the things I witnessed among my journey as a psychiatrist involved with treating patients in an often dysfunctional mental health care system that continues to become perpetually more dysfunctional over time. I felt that if people knew more about some of the inappropriateness that was often concealed or overlooked some might share some of the outrage I sometimes felt. I now realize that was just wishful thinking, for the most part. Much of the pessimism felt is due to the challenge that ordinary bloggers face when overshadowed by the professional media which often seems to have agendas other than what may be in the public best interest. Al Gore writes in his book Assault On Reason about how majority of Americans are programmed for TV sound bites and reading is not fundamental. Despite our super power status we still rank pretty low in terms of literacy as a nation when compared to other industrialized countries. This creates a perfect spin zone environment in that it doesn't matter what the actual truth is about a particular matter because it can be presented over the air waves in a manner that may trigger a strong emotional response resulting in the viewer believing the direct opposite of the actual truth. This happens all the time. Since all of the American media is owned by about five very rich individuals, the objectivity of the news reported is undoubtedly compromised. I believe that much of the news reported has been edited with unknown amounts of omissions. Irrelevant stories worthy of The National Inquirer often are substituted if the important news is detrimental to those controlling the media. Important stories are sometimes released at times when the least number of viewers are likely to be watching TV. This form of manipulation of the professional media also can work in reverse if favorable news is available.

My favorite news show is Jon Stewart's' The Daily Show because it has twice the news accuracy of Fox and admits to the intention of entertainment. Stewart and Colbert don't claim to deliver the gospel but do a reasonable job of addressing the most pertinent current topics in a humorous and entertaining manner. If I want objective information I find the Internet to be a more reliable source than TV because of the option of deciding for myself what is more likely to be accurate. I don't care for spin.

As I did a year ago, the time is again ripe to reassess the usefulness of my blog and determine if it's worthwhile to continue posting. I conclude that it is still fun most of the time and I plan to just play it by ear and keep free lancing. When people no longer find my thoughts to be of interest I'll probably quietly fade the Quest 4 Sanity site into the archives of blog heaven.

HEADoc's Reform Update

   

I've probably always been too much of an idealist and a dreamer when it comes to social problems and the realities in which we live today.

Avoiding challenges has never been my style. Even when selecting what types of patients to treat, the more difficult cases have seemed to find their way to me. I have learned so much about human behavior, and the world, over the past several years. I have learned my limits much better over time. I went to medical school hoping to one day make a difference. Upon graduation I felt I could do this most effectively as a psychiatrist and set out to meet the necessary requirements for practicing this art. I have engaged in the practice of psychiatry for over a decade now and feel another crossroad is inevitable in the near future.

I chose to practice within the public sector because the need seemed so great and I felt my efforts would be most rewarding here. I have worked in outpatient clinics, hospitals, jails, detox units, nursing homes, and office based. The work was always interesting but the systems did not always agree with me or me with them. Private practice has been the most fun, in most aspects, excluding the business component. Even with above average business skills (which I clearly lack) it has become quite difficult for one to get out and stay out of the red. It almost makes me want to cry when I think of the money owed to me that will never be collected and the ongoing game playing with third party insurers who will do anything to avoid paying you what is owed.

Even the North Carolina General Assembly Members in Raleigh admitted during a public forum on UNC TV Sunday that no doctor can afford to keep their doors open if they treat mostly Medicaid and Medicare patients. One in eight citizens in the state receive Medicaid. Cigarette smoking has been identified as a major contributor to consumption of health care dollars but lobbyist have fought to avoid further taxing of cigarettes. They admitted that North Carolina had taken the biggest hit in the nation in regards to lost and outsourcing jobs. Doctors in the town where I work have begun to go out of business. The ones closing up shop seemed to be seeing similar patients to the ones I see. The writing is on the wall, especially for mental health care. I felt better knowing that the General Assembly at least is not ignorant of the situation. They are quite aware of the fact that our state is screwed big time in continuing coverage for those in need of mental health services. They openly admit to having no solutions to the problem. Meanwhile, the area mental health programs slowly grind to a halt and the state mental hospitals begin to shut their doors  as predicted over the past years.

My hybrid private practice now open to referrals from the Mental Health Center has about reached its capacity. There are zero other providers in town accepting Medicaid or Medicare. Daily, I become more resentful of being told what I can and cannot prescribe. It only gets worse. Most of my joy came from autonomy and having control over major treatment decisions. This was even more important to me than the financial losses. I do not care for managed care organizations in the least. It is quite clear that they run the show. A perfect storm between managed care and the pharmaceutical industry is imminent. At least the pharmaceutical companies provide a useful service and product. Managed care organizations have one goal, which is to save money for their own use. I feel suspicious of any business whose purpose is to deny one their own benefits. In my opinion, that is why 50 million Americans don't have access to health care, the money is being siphoned away for administrative purposes to deny care to those who are insured. The bottom line once again is "who really cares?"

I once hoped I could retire from the type practice I'm doing now but must face the reality that things are not going to get any better than what the current state of affairs are. I really like the vast majority of the patients I treat and most of the time thoroughly enjoy the work I do. Taxes and overhead are unavoidable realities. For most politicians, whether my practice survives or not is irrelevant. When the 2008 election comes, many voters will again vote against their own best interest. According to Comedian Al Franken, voters will likely be swayed again by campaigns of Fear, Smear, and Queers. I have done the job I do out of choice, not necessity. Out of curiosity, I have found employment offers out in the private sector that would offer several times the yearly money I make with what I am doing now. At some point it becomes foolish not to consider entertaining such offers. Why should I struggle if I don't have to? I have no idea what will become of public sector mental health care but I predict it will not be good. It's a fact that funding for prisons has risen as funding for mental health care has been slashed. However, I will not speculate on that matter. I consider myself a voice in the wilderness and though I never found an effective means for changing things for the masses, I always cared about what the fate of the system would be. I still do. I suspect in 30 years after all the foolishness has failed, I'll probably hear of some young genius using my ideas to advise the leaders of how to fix the catastrophic mess they made of the mental health care system.