SunCloud Health offers integrative, intensive outpatient and partial hospitalization for adolescents and adults of all genders – “Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery”.

A Positive Step in Curbing Opiate Addiction

Everyone knows the drill: within seconds of entering a doctor’s office for a routine check-up, someone sticks a thermometer in your ear, pumps up a blood pressure cuff, records your respiratory rate and takes note of your heart rate.

These are your vital signs; if any one of your vitals is abnormal it serves as an indicator that there may be an active illness or disease state present.

Although the four vital signs were the standard of care for decades, in the 1990’s, level of pain was added as the fifth as part of a Veterans Administration initiative and became a Joint Commission standard in 2002. One problem at the outset with this movement is that pain, which is subjective, was referred to as a “sign.” Signs on the other hand, can be measured objectively, like the four original vital signs in medicine. If a thermometer indicates that the temperature is 96, then that’s what it is.

Regarding pain, the patient reports subjectively a number to rate their experience of it, typically between one and ten. Unfortunately, instead of taking the appropriate steps to determine the underlying cause of the pain or considering other alternatives, many doctors simply write a prescription for opiates; they do so without informing the patient, or even being aware themselves, of the risks involved with taking pain medication.

It has long been believed that this subjective assignment to pain and the doctor’s willingness to supply opiates is a contributing factor in today’s epidemic of pain killer abuse.

The American Medical Association (AMA), our nation’s largest medical society, seemingly agrees and now recommends dropping pain as a vital sign.

To its credit, the organization admits to culpability in this nationwide problem, saying physicians played a key role in starting the opioid epidemic by overprescribing pain medication, and now must do their part to end it. Another large piece of the problem is the lack of addiction training in medical schools and residency training programs across the country.

By improving physician training, improving prescribing practices, raising patient awareness through honestly describing risks and benefits of pain medication in the informed consent process, we can positively impact the opioid epidemic that is killing hundreds of thousands of Americans unnecessarily. Moreover, we can do so in a way that protects access to opioid pain management for those people for whom these medications are truly appropriate.

Addiction…A Choice?

Addiction to drugs or alcohol is a medical illness, a disease of the brain. And yet, there are those who continue to insist that substance addiction is a choice.

Several weeks ago, Matthew Perry, who portrayed Chandler Bing on the highly successful Friends sitcom, traveled to the UK to lend assistance to a new drug program involving the courts. While there, he appeared on a television show alongside journalist and anti-drug campaigner Peter Hitchens. A heated debate ensued.

Regarding his own addiction, Perry said, “I’m a drug addict and if I have a drink I can’t stop… if I think about alcohol, I cannot stop.”

Hitchens responded: “People have problems with drugs and drink. People like taking them and don’t want to stop. It doesn’t mean they have a disease.”

“Don’t want to stop?” How about the truth: so many addicts desperately want to never use again, but they can’t stop. Why? Because they are addicted, physiologically as well as psychologically.

Saying that a person addicted to drugs can “just stop” is like telling a diabetic they can simply toss out that insulin and be fine. That person will not be fine – that person will die.

Addicts don’t have a choice about whether or not they have an addiction, their choice is not in whether or not they have the disease but in whether or not they are willing to get the help they need on a daily basis to recover.

The “functional” addict

One of my favorite things to talk about with patients is their perspectives on functional alcoholism or addiction — whether in their own selves, their parents, or others in authority such as bosses, or the President. I ask with a curious mind, what is the definition of functional? Most people define functional as the ability to keep a job, show up at work, and even succeed professionally. Sometimes people mention the ability to show up at home or for social events. This is one way people defend themselves against the pain of acknowledging what they missed out on — the subtle, or not so subtle, cravings of their soul for nourishment that were left unmet.

Never has a patient answered me by defining functional as “being consistently emotionally and spiritually available.” The impact of active addiction on the soul and on emotional well-being is usually not considered.

We now have research from neurobiology on the impact of active addiction on our higher level cognitive functioning; animals that are “addicted” show a transfer of behavioral control from more highly evolved cortex of their brains to the dorsal striatum (less developed, reptilian brain). Scientists believe we will find the same in addicted humans.

We might consider what all of this means for us as a nation — we who chose a President who may be dependent on nicotine. Could he be an even better leader, think with a sharper mind, feel with a stronger soul, and breathe with clearer lungs without the cigarette?

Most people I know with addictive disorders are highly talented, creative and special people. Some are perfectionists, many are overachievers. The sad fact for every “functional” addict is that we will never know what his or her true potential is. In recovery, this potential does have the potential to be realized.


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