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PostPosted: Wed Jan 06, 2010 1:26 pm 
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Hi Everyone -

I posted the basics of this question/thoughts at the end of a long thread - but it's really a question that I'd like to see what people have been taught/learned, etc. Opiate Addiction Disease.

I tend to do quite a bit of research/learning about a topic before I jump - especially with drugs. I researched suboxone (actually bupe) for a long time. I learned about dependency, and addiction. I read about this being a disease - thus can be treated as a disease. SO....

I go to the doctor - and I get a bunch of information about the 'disease' of Opiate addiction. I am given a prescription called suboxone to treat my disease. I get in trouble with the doctor (he just stops our conversation and say's you have to be non-judgmental about yourself) when I refer to myself in any type of 'shame' or 'judgmental against myself' as that is not treating it like a disease.

BUT... I'm there for 3 months, in counseling, doing better than ever - and the doctor is like - OK, we are getting ready to taper you off right?

What the ??? Supposedly the doctors have been through training on this. They have limits on the patients they can treat. They tell us we have a disease, then quite quickly start talking about getting us to the place where the 'disease' can take us over again!

Sure, if the 'disease' is controllable by 'just say no' - I'm all for it. Where I am so dang confused is this whole notion of disease category. Is this like type2 diabetes where if I control my diet/weight, my blood sugar may be OK and I don't need insulin? OR, is this like a type1 diabetes, where I need insulin every day of my life?

Personally, the whole disease issue is confusing to me. Naturally, I want it to be like Type2 diabetes (therefore i taper off suboxone and all is OK - comparable to my change of diet/weight loss if type2 diabetic). But is that realistic?

Does this disease present differently in each person? Is it that I may have the 'you are OK off sub disease', but someone else has 'you are NOT OK off sub disease?'

Is anyone else confused about this? I feel like the only reasonable approach is to try the taper off method - and hope I'm in that category. It's just frustrating that they tag us with a disease, but can not come to consensus on what that means!

Is anyone wondering about this like me?


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PostPosted: Wed Jan 06, 2010 5:38 pm 
I hear ya Lathedude! I've tossed all that around in my head over and over again.
Disease? Really? Is the disease model just a handy excuse for my poor judgement....bad behavior....loss of self control? Is it a theory I can use to soothe my tortured conscience?
Or is this a disease? Were the beginning stages of my drug use innocent enough that I can accept that changes occurred in my brain at some point which then allowed me to label my drug use/abuse from that point forward as an illness? And from then on I am an addict....a person with a disease? Does that then mean that once that obsession/compulsion kicked in that I am no longer accountable (or at least not completely accountable) for my behavior? Is this disease then comparable to something more like depression or OCD - diagnoses that one simply cannot "snap out" of? I don't know.
It is all very confusing.
Like you said Lathedude, then what about treatment? If it's truly a disease and we equate it to diabetes or hypertension, we can plan on needing medication(s) for the rest of our lives. Even equated more to mental illnesses, a lot of those diagnoses require lifetime treatment and/or meds. But yet, many physicians want us off Suboxone in some certain timeline. Doesn't make a lot of sense when you think about it that way. Further, the outpatient treatment programs or even inpatient treatment programs for addiction are not nearly long enough for most of us to have any kind of long-term recovery. I don't get it. I know a lot of it is money driven or insurance reimbursement driven. I'm not talking about Sub docs taking kickbacks or bullcrap like that, just bottom line health care cost issues that pervade most every aspect of healthcare, not just addiction.
These are very deep questions/issues that I sure don't have the answers to. I'm sure others out there have strong opinions or knowledge about this. I don't. I'm just talking about my feelings or thoughts about the subject here.
For me, just knowing that I'm better, that I'm working on things, that there is not only hope at this point for change, but that there have been and are changes taking place, has to be good enough for now. Will I ultimately be cured? Right now I'm going to say that I believe the answer is "yes". Please don't bash me for that answer. I'm entitled to my personal beliefs and I believe that I CAN be delivered from this.....not in purely a supernatural way although that is a part of it. But by doing the necessary work and taking the necessary medications for the necessary period of time....I think there is hope for me. I think there is hope for all of us. That's just me. Everyone is different. Everyone's history is different. I'm not saying I'm special and I'm not stupid either. And if it's more correct to call it "remission" than "cure" - that doesn't bother me a bit. Further, if my "deliverance" doesn't come in the form that I hope for (completely drug free) that doesn't mean I was wrong. If "remission" means I have to take a little dose of Suboxone for the rest of my life, that's not a failure. It just means my "cure" takes a little different form than I have made in my human, flawed mind. I think I'm making my own head spin now. Sorry.
I guess what I'm saying after all that is that the old "one day at a time" thing really does apply. Does it matter what we call it? I just know how I feel about addiction. I know what it did to my life. I know I don't want to go back. I know I couldn't even really get "recovery" started without Suboxone. I know I am better.
I'm real lucky too in that I have a super doctor who I just saw yesterday. When discussing tapering, going off or staying on Sub - his response was that he's good with whatever. As long as I see him once a month, if I want to stay on Sub - fine. If I want off, he'll help me. Pretty lucky.
Well that went on and on as usual. I would really like to hear some more replies on this subject. It's very thought provoking.


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PostPosted: Wed Jan 06, 2010 8:16 pm 
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Boy, this a big subject for me. Disease usually stricks a VICTIM, I find it hard to be a victim when I abused, I did this to myself to feel good.. The pain killers would have sat on the shelve forever , for me it was a loss of self control... I FAILED at self control, I believe theres time to put any broken pieces back together... I respect everyones different way at looking at this.. Also I have a great Doc, he asks that I take a small chip off my 2mg pill evey month. I'm at about 1.75 right now. I dose 1 pill daily.. He is not rushing me at all. After my neck surgery 2 yrs ago, I should have stopped taking the Pain Pills, or looked for help then with my addiction problem which I knew I had, Mike


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PostPosted: Wed Jan 06, 2010 10:38 pm 
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Deciding whether or not addiction is a disease I think polarizes many in the medical field. The contradiction that was pointed out - i.e,. it's a disease, don't be so hard on yourself, then comes the "let's get you tapered off" is very real and makes for a very real sense of confusion.

All diseases come in different forms with each person. For example, my family is chocked full of sub-abusers, so "they" say I was pre-disposed. I mostly agree with that. And I think that lends a bit of credence to the disease model.

But like all medical conditions or diseases, it's complicated. Those with high blood pressure need medication, but they also are responsible for risky life choices.

Disease or personal flaw is so very black and white. Like nature vs nurture, which is most likely some of each. So like most things in this world, it's probably more of a gray area.

Considering my chronic pain and my insatiable appetite to be numb (which has gotten much better over the last year), I plan to be on Suboxone long term. But that's just me - everyone is different and different doesn't mean "wrong".

Anyway, just my humble 2-cents worth. Great topic!

Melis


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 Post subject: Disease... Illness...
PostPosted: Thu Jan 07, 2010 12:50 pm 
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This is an interesting topic. Now that MD's can be certified to prescribe Bupe in their office... a whole new can of worms has been opened. Many of these dr's must be motivated by income, and the more new patients they can process thru... the more income they will make. This is mainly because of the upfront office visits and frequency of visits for newer patients. After a patient is stabilized... there is not much money left for the dr to make.

The limitation on the number of patients these dr's can treat, could create a big problem for them... both ethical and moral. There is also the malpractice issue for them to consider. I would imagine their additional premiums for Bupe treatment are enormous.

The AMA needs to better define opiate addiction [if it is a disease] and come to some kind of agreement of what is the appropriate long term treatment model.

http://www.ama-assn.org/ama/no-index/ph ... 3352.shtml

http://www.ama-assn.org/ama1/pub/upload ... ummary.pdf

I know there are good dr's out there trying to help patients become free of opiates... including bupe, but what criteria do they use to detrmine if someone is ready for a taper off or is best kept on long-term maintenance???

I'm afraid this subject will raise more questions than answers...


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PostPosted: Thu Jan 07, 2010 4:15 pm 
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Thanks for the input so far! I actually watched a suboxdoc youtube video after I posted this - where he talks about his opinion on opiate addiction as a disease. I'm OK with the diagnosis - where I get my confusion from the medical profession is how they decide mild/moderate/severe? It feels like one size fits all with my doctor - everyone taper off.

But, I read about others who's doctor say 'no pressure - maybe you'll be a lifer on suboxone - and that is OK.'

I'm good with whatever keeps me in quality/productive life without substances controlling me - like opiates.

I hope many more put their experiences, and opinions about this. I think it's like there has been one step taken in opiate addiction - It's a disease... but where is step 2? Most diseases - get further testing or something - and get categorized as either a stage 1,2,3 or mild, moderate, terminal... something.

Looking forward to others on this topic... wish Dr. J would post his feelings on this too! Maybe his youtube video is his reply - but I still think it's not very specific about the second step in identifying where a person is in their disease.

THANKS AGAIN!


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