Addiction Treatment: A Step Toward Healing

August 23, 2011

Addiction Treatment: To use counseling or not...

I am always curious about human nature and the choices we make in life (probably relating to my undergrad degree in Psychology). In studying the disease of addiction for my board certification test, I wondered why it took so many attempts at rehab before a patient would change his/her lifestyle (on the average 7 or more tries at rehab). Part of my problem in understanding, I am sure relates to my not having had to deal with the disease personally yet. But it had always seemed to me that if you wanted something treated you would follow medical (or counselors) advice to get the job done. The introduction of Suboxone has been an eye opener in this realm. Most doctors treating opiate addiction follow the old model of detox, and counseling to help the patient clean up, and few believed in maintenance as a lifelong treatment philosophy. Those that had worked in the methadone maintenance programs understood the realm of maintenance, but counseling and meetings were part of the system, and the patient had no choice. But now Suboxone allows the patient to stay on maintenance, feel normal, and never have to deal with their personal issues. For some patients, who have been through multiple rehabilitation’s and are veterans of a 12 step program, Suboxone is a life saver. These folks don’t take to formal meetings because they have already built up their support system and continue to work with their sponsors and friends in a supportive environment.


But for the younger addicts, so long as they feel normal, often seem to see no need to pursue further treatment. These are the folks I do not understand. Most of them will admit to their emotional immaturity if pressed, or to continuing in their habits of addiction (“I take my suboxone and cut it up so I can use it 4 or 5 times a day”). They see no reason to cut ties with their actively using friends, or their dealers, and are at most one weekend away from going back to using. Many of these folks continue to relapse regularly, but somehow still believe they are in treatment.


As a physician I understand and will continue to work with folks under the realm of harm reduction. This means I will allow them to Suboxone to keep them from buying illegal pills or heroin. But I don’t want patients to think that I believe they are doing well or working toward healing their disease. If they do not receive counseling or involve themselves in a support structure like 12 step or Rational Recovery they are not actually in recovery. They are fooling themselves and often I get the impression that they also believe they are fooling me. I understand they are one weekend away from their addiction relapse, and it is sad to see them fooling themselves and thinking they are fooling others as well.


Filed Under: Dr.s Notes


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