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.