Thursday, February 18, 2010

Everything I encounter in practice tells me the direction I'm headed is the right one. Saw yet another person today with alcoholic pancreatitis who I had not previously met someone who understood both how difficult it is to cope with the really awful chronic pain of pancreatitis, as well as her alcohol dependence and recent relapse and her bipolar disorder. I like being back in a hospital, getting to know the nursing staff, the hospitalists, and of course, the patients I see. I'm surprised at how many people I'm seeing in private practice who have very serious problems with substance use. There is such a stereotype that people who have substance problems are low-lifes who can't cope. Of course, I've always known better, but this experience is reinforcing it. To my mind, it's astonishing how few people have had access to truly competent addiction psychiatry. For these folks, another run through rehab is not the answer. I've seen several patients recently who are actually quite good at managing their various chronic medical and psychiatric conditions but who have had a slip or relapse of their substance use disorder in response to severe environmental stress. As I explained to a nursing student today, relapse in any chronic disease can be understood as the place where each of us has a breaking point. Under severe stress, some of us will lose control of our heart rhythm, our mood, our glucose control or our chronic pain. Where each of us loses control differs primarily by genetics and our particular situation. There is no point in condemning those with some chronic illnesses (depression or bipolar disorder, addiction or schizophrenia) and not others (asthma, heart failure, cancer, or arthritis.


Over and over, everything I'm encountering in general psychiatry practice is affirming the need to offer updated, scientifically based treatment for people who overuse or become dependent upon intoxicants.

1 comment:

  1. Hello Doctor Willenbring,

    My compliments on your blog and on your overall efforts to bring better treatments for overusers etc. Keep up the good work. That said,I was a bit surprised to read that you are surprised at the number of people with serious substance abuse issues.I'm a recovering alcoholic, and have been in AA for several years now. I see a constant stream of people whose lives have been destroyed by not just alcohol, but perscription drugs such as Oxycotin, Vicodin etc. My best friend, and long time drinking pal, hurt himself skiing in Colorado three years ago, and his doctor perscribed Vicodin ( or was it Percocet). Gave buddy a persciption for one hundred pills. I asked one of my hardened and recovering drug friends ( twenty-five times re-hab, which makes him something of an expert in my world) about the length of time my Colorado pal could safely scarf the goodies. Three days, he said, three days and an addictive type will be hooked. That's six pills, and here my buddy was running around with a buzz on and a big bottle of pills. Make a long story short, my Colorado pal is now out of rehab ( this one ninety days) but has lost everything.Wife, house, dog, job, the works. I find myself wondering what that doctor was thinking of, or was he thinking at all. We have plenty of this going on here in Canada so I'm sure not pointing fingers. At the street level it isn't pretty. But it's going on in board rooms too, and we all know it. It was my world for decades. Good luck with your efforts, and I'll chime in with my greetings from time to time. All the best, Al from Canada

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