Substance Abuse Feed

Human Connection vs. Addiction

I recently watched an interesting Ted talk, Everything You Think You Know About Addiction is Wrong by Johann Hari.  Great stuff.  Hari makes some interesting points.  Among them:

Simply giving someone opiates can't turn them into a drug addict.  

Our culture has taught us that giving someone opiates will cause them to become an addict.  I've known doctors who worry about prescribing adequate pain medication because they don't want to "make" the patient an addict.  As a result, doctors typically under-medicate pain.  I personally think the under-prescribing of pain medications may contribute to addictive thinking and behavior, but I've never known it to cause addiction.  What's the difference?  Under-medicating patients tends to make them more anxious about being treated adequately for pain, so they may begin to hoard medications or skip doses so they can double up later, etc. because they don't trust the doctor to adequately control their pain.  Addiction, on the other hand, is not about controlling pain, but about feeling the high.  Drug addicts skip doses and hoard their medications so they can take large doses all at one time to get the high.  However, the under-prescribing of pain medications now has a healthy person thinking and behaving like a drug addict - out of fear.

Think of someone you have known who has had a lot of surgery - and the heavy duty pain medications that go with it.  Hari gives the example of grandma having hip replacement surgery.  Grandma completes the surgery, recovers and is not an addict.  

So what is the difference between someone who is exposed to opiates and becomes an addict - and someone who does not?  Hari maintains it is the quality of their lives.

Rats can't be made into heroin addicts - if given other options

Hari cites a study of rats in cages who had a choice between water laced with heroin or regular water.  Rats living in barren, empty cages always chose the heroin water.  However, researchers found if they housed the rats in cages equipped with all the things rats love, toys, other rats to play with, comfortable beds to sleep in, etc. (a kind of "rat park" as Hari calls it), the rats don't choose the heroin laced water.  Point?  Rats with full and happy lives don't choose heroin.

Why is this important? 

We are finding that human connection and a healthy "rat park" is what keeps humans from becoming addicted.  People with full and healthy lives don't want to be intoxicated or numbed.  They want to be aware so they can enjoy their lives.  

What does this mean for our treatment of the addicted?

The criminalization of drugs prevents people from re-entering society.  A person convicted of drug charges has a criminal record.  This labels them as criminals, shames and humiliates them, associates them with a criminal element in society, prevents them from obtaining employment and housing and impairs their healthy relationships.  It effectively hampers them from re-entering human society as effectively.  They are shamed and stigmatized and left with little to get out of bed for.  Being imprisoned severs their connections with family and friends.  

Perhaps we should treat the addiction rather than punishing the addict -  keeping them in society instead of removing them from it, requiring them to participate in drug treatment instead of locking them away with criminals, requiring them to work instead of hampering their employment, teaching them to parent instead of removing them from their children - this might be a better solution.

Prescription Drug Overdoses Now Outnumber Deaths from Heroin and Cocaine Combined

I wish I could say I didn't see this coming.  A few years ago I worked in a methadone clinic which treats people with opiate dependence.  It quickly became apparent that the prescription drugs OxyContin and Xanax were more problematic than the heroin we were treating.  Even on my small case load one of my clients died, another lost 60% of his kidney function and many others suffered serious impairments to functioning. 

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Trauma Tourette's

I was once working with a child who was also seeing a psychiatrist.  Like many children with whom I work this child had numerous diagnoses:  ADHD, Bipolar Disorder, Anxiety Disorder and Intermittent Explosive Disorder.  However, when the mother would describe the child's behavior I would instantly think "trauma".  I kept saying this to her, but she was swayed by the authority of the doctor and maintained his belief the child was mentally ill.  Until her child told her he had been sexually and physically abused.

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Staying Sane During the Holidays

Though the holidays are supposed to be a time for family, for celebrating and for taking a break from work, they can sometimes have the opposite effect.  Old family battles can be resurrected, celebrations can become calamities and the rest we hoped to get dissolves into a flurry of shopping, planning, packing and partying.   Maintaining your own peace of mind during the holiday season can be especially challenging.  Here are some ideas to reduce your holiday stressors:

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The Prostitute in the Alley

I work in a homeless shelter so I see a lot of street people.  While leaving the building the other day I overheard two coworkers derogatorily discussing a well known prostitute who was in the alley.  It made me sad.  If only they knew.

Most prostitutes I've worked with have had a long history of sexual abuse, often starting in early childhood.  They were trained as children that they were on this Earth to provide sexual favors to whoever asked.  And they carried this into adulthood.  Drugs and alcohol are often involved to numb the emotional pain of the early sexual abuse.  Many attribute prostition to drug or alcohol abuse, but the sexual abuse often preceded the addiction.  The person continues to use alcohol and/or drugs to numb the pain to the continued sexual abuse as an adult.  So when I see a prostitute, male or female, this is what I think of.  They should not be a subject of scorn, but of empathy.




Psychiatric Medications as a "Crutch"

Throughout the years I have worked with several clients who were criticized or rebuked by family members or Alcoholics Anonymous sponsors for using psychiatric medications as a "crutch".  Yes.... and?

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