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.