Tuesday, February 16, 2010

Medical/Psychiatric Treatment of Addiction

The past two 6 weeks I've been in the process of practicing in a new environment, learning all the rules (official and unofficial), the technology (not simple or quick), and of course, the nurses, administrative staff and patients I work with on a daily basis. I've been having a lot of fun. Practicing general and addiction psychiatry is very gratifying, in part because I'm offering other medical staff and patients services they've never experienced before. People are baffled, befuddled. They are so used to the idea that treatment for addiction is education, group counseling and 12-step programs that the idea of the medical and psychiatric treatment of addiction is completely foreign to them. They are intrigued; I'm concerned about the deluge as word gets out. They've been truly desperate for it; they've had to do what they could on their own. Obtaining a "chemical dependency" consultation essentially consisted of two options: yes and no. That is, yes or no to rehab. Or, there had been so many runs through rehab that they weren't eligible for another "run." At any rate, treatment for addiction was not medical or psychiatric; it was social and spiritual. I don't denigrate peoples' spiritual experiences, they seem to be profound and uplifting experiences for many people. At the same time, when a medical condition is treated by spirituality, it suggests that there is no actual medical treatment for it. This is the history of medicine: when all else fails, pray. The problem is this: medical/psychiatric treatment of addiction is possible, feasible, cost-effective and has an excellent empirical base for it. The evidence base for treatment of addiction is better than for most medical specialties. In some cases, patients are lucky enough to find me in time, in others, tragically, they are not. They only obtain access to scientifically based treatment after suffering devastating consequences of their substance use. This is nowhere more apparent than in the treatment of chronic pain. The treatment of chronic pain in the US is extremely limited and ineffective. Patients are routinely labeled as "drug-seeking," a term that is not actually descriptive, but a value judgment.  I'll have a lot more to say about that in the future. In the meantime, I'm interested in hearing about either living with chronic pain or professionals who are treating chronic pain.

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