Substance Abuse Update

                   

Today was a good day, much better than most ...

Those who follow my writings know of the growing dissatisfaction and frustration I have developed toward drug addicts, in general, especially crack cocaine addicts. Despite those emotions, I continue to work part time in a detox facility. 70% of those in addiction recovery will fail within a year of starting treatment, some will fail multiple times within that 12 month period.

Who would want to bother treating a group of people with such lack of promise? I grew up around many such people which is probably where the commitment originated. At a recent CME workshop I commented to one of the presenters that I felt I could help, to some degree, any individual who was willing to comply with my recommendations and cooperate with treatment. He told me that I was grandiose in my thinking. Maybe I was. Maybe that is why I have had so many problems within my clinic over the past couple of years since beginning to treat more chronic pain cases. It has been one of the greatest learning experiences of my career if nothing else. My new sub specialty has seemed to become identification of drug abusers and criminals and removing them.

Though, only a small percentage of my practice is actually pain management, the majority of my stress originates from substance abusing sociopaths disguised as normal patients. I suppose I have always felt compelled to accept a challenge and this has led to taking on patients that most other doctors would refuse to treat. I am pleased with the progress made in establishing better defined limits for those patients likely to benefit from treatment and those who are high risk and a waste of time. Medical school gives the false impression that a good doc will one day stamp out most pestilence and disease. Advancing along in the training process reveals a more clear truth in that there is a limited amount of patients in which a physician can make a major and lasting improvement in their condition. This is especially true for the specialty of psychiatry. Even though we have trillion dollar miracle pills for certain conditions, those pills aren't worth diddly squat if the patient doesn't comply with your instructions for taking the medication. So even in the best of circumstances we may significantly improve the lives of 50-60% of our patients, usually the patients able to comply well with treatment.

I find that most physicians avoid or shy away from treating severe anxiety and chronic pain because of the infiltration of the medical community by substance abusers who may put their license at risk. In my state, usually, persons who break the law with behaviors such as altering prescriptions, calling in their own refills, obtaining meds fraudulently, or selling controlled drugs are not aggressively prosecuted in my experience. The DEA system is set up more toward finding and weeding out physicians who prescribe inappropriately. This system has created a more concentrated and vicious population of substance abusers and divided physicians into those who will treat and those who won't treat. I'm still one who follows my conscience when it comes to treating chronic pain with opioid medications and severe anxiety with benzodiazepines. I still believe that about 75% of these patients benefit from the use of these medications when appropriately used. It is the other 25% of those seeking treatment for these disorders that carry a very high risk and cause problems for well intending physicians.

I have learned that most of these people in that 25% bracket are just sociopathic and must be identified as so and dismissed or avoided. They can be offered treatment for substance abuse but most will refuse or not comply due to their denial and lack of useful insight. It isn't considered a challenge to treat one who doesn't want appropriate treatment but is more so an exercise in futility. My practice had to release over 50 patients for violations of the controlled drug use agreement or outright criminal behavior during 2006. I will not allow those bad apples to cause me to deny treatment to my honest patients who do benefit by refusing to prescribe any controlled drugs where I feel appropriate.

I believe in principle, and the threat of having my DEA license suspended hasn't stopped me from doing what I feel is ethical and the right thing to do. I went before the State Medical Board in an informal inquiry last year to defend my developing practice policies in regards to the matter of prescribing schedule 2 narcotics. The main advice I received was to make sure my Continuing Medical Education was up to date and to improve my chart documentation and know when to refer or dismiss inappropriate patients. I tried to use the opportunity to shed more light on the practice environment for the average practitioner outside the metropolitan areas. It was made clear to me that wasn't included in their scope of concerns. Basically, I was told to work on saving my own hide and forget about social science. This caused me to feel conflicted and depressed for a while. I finally accepted that the only way to survive in the world of private practice is to practice self preservation which is to treat as few high risk patients as possible by learning to quickly identify those who probably aren't sincere about help and allowing them to flow downstream to the next unsuspecting but compassionate practitioner. This may be a bit poignant but this is reality in our health care system. Also accept referrals from reliable sources only. Eliminate walk-ins without a referral from a legitimate provider. Use well defined written agreements signed by you and the patient. Enforce violations of the agreement promptly and effectively. Improve communication with pharmacies and become working partners with law enforcement.

Today was a good day because in it I felt some hope. I saw a recovering alcoholic with panic disorder who had been sober and clean for almost 6 months and was working a full time job and handling his stressors without the use of alcohol. I had met him in detox several months ago. Today, I wished him well and felt good about being involved with his treatment. I also saw a chronic pain patient with Post-traumatic Stress Disorder who I feared greatly was primarily a substance abuser during previous visits. Today we talked about how the evils of incest had affected her life and her ability to mother her 4 children. She expressed readiness to accept help from an outside agency with the 2 oldest kids whose behaviors have become unmanageable. She arrived at this decision herself despite opposition from family members who offered no better solutions yet were critical of her. Today I know that she heard me and I felt more comfortable that she wouldn't choose to medicate herself into numbness as a primary coping mechanism. Finally, I saw a young post-partum mother who was on methadone for chronic pain for the past 13 years for pain associated with spina bifida. She had no significant history of substance abuse or mental illness. Her OB-GYN saw her through a successful pregnancy last November and had the courage to keep her on her methadone to avoid the complications that would arrive through withdrawal if it were stopped. He then had to refer her to a primary care doc whose main agenda was to taper her off the methadone. Methadone can be a miracle for one with a chronic pain syndrome and no substance abuse issues. It is perfectly legal for any doctor to prescribe it for the purpose of chronic pain control but not for addiction maintenance. Most doctors avoid it due to risks and inviting the Federal government into their practices. I thought she was a perfect patient for me to treat and accepted her care without a problem. She rose from near despair to elation upon discovering she could get the help she needed from me. I felt good about the decisions I made over the past year refusing to allow addicts to make me be unable to provide care to the truly needy. Today was a very good day.

Might Wanna Skip This One

   

I find that no truly original ideas or memories exist...

Chances are that in the history of man, somewhere at some time to some degree, some human brain has experienced that exact information. This realization initially crushed my ego because arrival at truth often reveals that I wasn't the first. My narcissistic injury is somewhat repaired by the knowledge that advancing our collective thinking in the context of certain moral and ethical standards is what truly connects us with divinity.

These words may suggest that I am stoned out of my mind with some substance of abuse but that is not the case, I can assure you. This is an example of that zone we can sometimes reach during those wee hours of the night when the ability to sleep vanishes. All of the background garbage thinking and self judging and criticism are at the lowest possible level. Truth begins to flow through the mind. Some refer to this as a period of deep meditation. Out of a sea of many thoughts the mind must assign value to those most cherished.

I just remembered the dream I was awakened from by a knock inside my head. The dream was actually violent in nature and simple about logs of a variety of sizes falling into a small but deep stream of water. I was trying to advise others how to avoid being crushed or pinned and drowned by the gigantic logs while attempting to save myself. It was hard to communicate this to these vague other people. Simultaneously, there was an area with many much smaller branches and twigs on the bank that I worked feverishly to clear away as the dream took on indescribable dimensions of the fertile soil being penetrated in a gradual manner and souls being released as I jumped and chanted in jubilation and amazement. These words can only describe in a superficial and simplistic manner the visual imagery and emotional tone of the memory of the dream I was experiencing several minutes ago.

To the average reader this material again may seem consistent with one who is psychotic or high as hell from a mind altering substance. I can assure you once again I am not but more so just free associating through the use of a keyboard. This entry may only have meaning for myself when I reflect upon it at a later time  I suppose that since my writing is just a hobby and I have no intention of profiting financially from it at anytime that every now and then it is ok to just use the space here to just write totally off the top of my head. I hate restrictions but understand the necessity for them.

I think my original point for this entry was an attempt at illustrating the context of the reality of this individual human's thinking and thoughts. I learned from Deepak Choprah, author/spritualist/physician that the human brain is usually aware of one part out of a billion parts of the total of reality. Most of what really exists can't even be imagined and we can't even imagine that we can't imagine it. As an example, quantum physics suggests that if you think you understand quantum physics then you don't understand quantum physics.

The closest we can come to an acceptable understanding of ultimate reality is through the concept and idea of God. God is so hard for us to comprehend and communicate to others that it sometimes frustrates us to the point we respond aggressively or judgmentally toward our fellow man or we justify making him or her an enemy and attempt to destroy that individual or individuals in the name of righteousness. It stretches from Cain and Abel to George and Saddam from an idealistic view. It will continue.

For the political finale today I wish to comment on the idea of conspiracy theories. I'm certain that what I have written so far will really make people trust and believe me.(not) It does really help make my point, however. I never suggest that people smoke pot or drop acid but the few people that really catch my drift for this entry will likely be stoned out of their gourd. I just wrote it as it flowed to me. You'll either get it or you won't have read this far anyway. This final point is that I want to state my awareness that 95% of conspiracy theory material is total B.S. Certain people in certain high places, however, are intelligent and crafty enough to capitalize on this fact and use it to their advantage. Remember that 5% of conspiracy theory is not theory at all but totally true. For most people it all boils down simply to "who do you trust the most?" I have a clear understanding of deception and things not appearing to be what they are because of my background and experience. I don't expect all others to think in the same manner as myself. There are those who fully trust my thinking, then there are those who absolutely and totally reject my ideas. I can accept that. I am learning to ignore those who don't see the same light as myself. Why bother? I'm an abstract thinker much of the time and am aware that concrete thinkers won't always be compatible with most of my views. In reality, there are two sides to every story with the real truth laying somewhere near the middle. That, my friend, is a fact.

What this meandering leads me to finally write is that there is a 100% chance that we have never been told a fraction of truth about 9/11 and the true extent of the involvement of our government and what the real intentions are there. I think it's ok to admit that sometimes it is better not to know the truth because then you don't have to ruin your plans and start dealing with it. This is sometimes referred to as willful ignorance, which at times I too have been guilty of. As far as UFO's, space visitors, AIDs and crack conspiracies, JFK, RFK, MLK, NSA, FISA, FEMA, CIA, FBI, PNAC, skull and bones, free masons, crop circles, pyramids... I just do not know. I do firmly believe in that 5% truth principle. On the other hand, I am convinced that the true 9/11 conspiracy theory is the one the government wants us to believe. When the true facts are placed on the table the story the public has been given by the government is ludicrous. At this point, I'll rest my case.

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State of the Union (in my opinion)

As a loyal, patriotic American I feel it is my duty to offer my two cents on a periodic basis...

I think our country has become the most divided it has been since the civil war. Some may wonder why. As a country we have become like two siblings having an ongoing disagreement. Freud developed a term known as neurotic transferrence in the context of an individual undergoing psychoanalysis. An individual's behaviors and beliefs are merely manifestations of the impressions made by the parents and all ensuing personal encounters with others during the child's formative years. Developmental Psychology experts would unanimously agree that a direct correlation exists between adults with severe personality disorders and problems with early parental bonding and relationship building during the developmental years. It is common that grown men and women spend their adult lives reliving their childhoods and attempting unconsciously to resolve oedipal and paternal conflicts. People with such issues act them out in all sorts of ways. Usually, the consequences are confined to small family or social units. On occasion, impaired people end up in places where they have great responsibility for the welfare of others.

Some people cannot think in abstract terms. The world is always interpreted in a concrete manner. They are more likely conform to fundamentalist religious doctrines and literal biblical interpretations. The modern Republican Party is a haven for such a mentality. A Myers-Briggs or MMPI will easily identify such personality traits with features of strong judgmental tendencies toward others, easy to anger if disagreed with, inability to experience an evolution or useful growth of their knowledge base. Hypothetically speaking, if such a person were the leader of a great nation that somehow became mired in an unwinnable war, such an individual would probably continue to ignore advice from knowledgeable people and insist on doing things his way despite the costs in lives and human suffering. Men of such character historically have fought 'till the bitter end. Remember General Custer. Thinking and truly moral individuals must pray that the next two years end at record speed. There is not a lot of faith remaining for our legislative branch to save our country for in the recent past there has been little support for dissenters showing back bone. Just like the average government employee most Congressmen and Senators think of saving their own skin before anything else. Constituents don't really matter except during election years.

The current administration is a behavioral scientists dream. After this is over there will be scores of books written and movies made on the years America slept. Most who would speak out now are too intimidated to risk reputation and even life to take risks that won't profit them at all in the current political environment. The power of the NSA, CIA, FBI, IRS, DEA, Secret Service are obvious to informed individuals. It is not science fiction or paranoia that these agencies can and do literally get away with murder. The safest policy for citizens remains one of total ignorance and fear. If you are an ignorant coward your government will protect you.

I have developed into what has been labeled a liberal, which I take pride in. Lately, I have developed a respect for true conservatives. Neo Cons have a way of changing any persons thinking. I draw the line at Ann Coulter, Sean Hannity, Rush Limbaugh, Pat Robertson, Jerry Fallwell, et al. To me they are intolerable extremists. But now I will listen to even Pat Buchanan and find common ground here and there.

I have lost all trust and faith in the current government. All my hope lies in 2008. I hope our country will continue to awaken from this seemingly never ending nightmare we have allowed ourselves to slip into. Many people who read this will see me as the one lacking an understanding of reality. I ask that you file the page away in a safe place and come back and read it in five years. I am confident your thinking will have changed greatly by that time.