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 Post subject: My poor 'bedside manner'
PostPosted: Mon Jul 20, 2009 7:39 pm 
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I receive about a dozen e-mails each day asking for advice; some are quite long, and while I would love to be more helpful there are days when I don't have time to even read them, let alone answer-- so please understand if I have not gotten back to you. One thing that has also 'soured' me a bit on personal communication is that I forget just how messed up addicts ARE-- how distorted their world becomes, and how frustrating it is to become involved in trying to help someone who is not yet ready to be helped. I am going to post an exchange I had yesterday and today with one such person... I was way up north this weekend and not connected to the internet, but I received an e-mail on my i-phone and at the time had nothing to keep me from reading it. Having read it, I felt sympathy for the person and gave my honest opinion on the person's dilemma.

I don't have time (of course!) to make comments all the way through, and so I will only post the exchange; my goal is not to humiliate the person, as nobody knows the person's identity. But for those of you who are enjoying some sobriety, the exchange will be useful; you will recognize the self-centeredness and self-pity that prevent sobriety from taking hold. In a treatment center, this person would be given a choice: shut up and listen, or leave and return when you are ready to shut up and listen. She wants support, I suppose-- but support will kill her. That is one of the most fatal, and most common, mistakes made by using addicts; that they need 'support'. That thought allows them to reject all of the calls for change that people take the time to provide. She will keep going from person to person, looking for someone to be 'supportive'. But the only thing that will sound 'supportive' will be advice that keeps her right where she is! 'Support' for a using addict is only another form of enabling.

Now, once a person is at a different point of treatment-- at a point where she is following instructions, and has gotten past the self-centered 'terminally unique' position-- a certain amount of support may be useful. But this person is not even in the ballpark for that approach. If she is reading (and I doubt she is, as addicts tend to avoid reading things that stir up awareness of a need for change), I recommend she drop the one-woman pity-party and realize that her life is up to HER, and her alone. If she doesn't get serious, she will end up just another dead junkie-- and for that I am sorry. But I can promise you that me being a bit 'kinder' would not have been the answer to keep her alive.

Her Note:

Hi Dr. I am writing to you for help. I am a forty year old female who has been addicted to opiates for twenty years. Eighteen months ago I got clean (mainly from Norco and Fentanyl). I felt wonderful for months and then the pain started again (or my head said it did?) I have a disc protrusion. I went to my psychiatrist (also an addictionologist) who presbcribed suboxone. Now almost a year later I am on 8mg 3x per day for a total of 24mg. I hate this medicine. I am numb just like when I was on vicodin! I cannot go to the bathroom I have severe constipation and have to do a relistor injection every 48hours and take six stool softners and four laxatives to go to the bathroom once a week! I am having rage feelings again just like when took too much vicodin and I am flying off the handle at people, I am angry and numb and I hate everything. I don't tell my AA friends that I am on subs because I am ashamed of it and I feel like I am still in active addiction. I have tried to get off it and every time I end up back up to 24mg. It does all the things it's not supposed to do, I crave it just like vicodin. When I was down to 12mg I was unable to stay at that dose, I had to take more, just like vicodin! I know you''ll say that's not possible but there it is anyway. Some days I take 32mgs and it's hard to stop myself????? I want to stop this stuff so bad and I can't and I'm petrified of the side effects and going through withdrawl again. Somehow I convinced myself that I could wean myself off subs with vicodin!! I didn't taper off the subs (I couldn't) and yesterday I had had my morning dose (8mg) and then five hours later I got a script from my dentist for Vicodin and stopped the subs and started taking the vicodin and of course now I can't stop so yesterday I took 4 and a half tablets (7.5mg tablets) and today I've taken three already and it's only 2:00pm. What's going t happen when I run out of vicodin? Am I going to go into withdrawl anyway? I am so scared right now and I am too ashamed to call anyone, my therapist, my psychiatrist, my sponsor... anyone! Please help me if you can.

My Note:


Hi-- thanks for writing. You are not alone in your situation; the bottom line is that Suboxone is only a tool, and if it is not used correctly, people will not do well with it. The person treating you should have 'reigned in' that extra use right away by refusing to give early refills; after a couple times of running out early and having withdrawal, you would have learned to keep the dose under control. At this point, I just don't know if Suboxone is the right med any more for you-- you need some way to get your motivation back, so that you will be able to limit yourself. That usually takes a bad experience that gets you to some sort of 'rock bottom'. Addicts repress the feelings of shame you refer to-- the goal of treatment is to keep those feelings from being pushed aside, so that you will remember them when you need to do the right thing for your health. A few suggestions: -read my blog, suboxonetalkzone.com, the post on optimizing absorption of Suboxone-- make sure you are getting it in your system in a high-enough concentration. Search on the blog for 'optimizing absorption' and you should find it. -the effects of Suboxone peak at about 4 mg per day; everything else is psychological. You want to dose ONCE per day-- take 16 mg in the MORNING ONLY-- one tab, and then the other. If you get cravings later, you need to distract yourself for 10 minutes, and they will be gone. YOU CANNOT JUST KEEP DOING WHAT YOU WANT TO DO. You have the power to make it work, but perhaps you have a personality where you usually get away with bending the rules. IF YOU WANT TO GET BETTER, YOU CANNOT BEND THE RULES. These things I am suggesting MUST be followed if you want them to work-- you cannot do just what YOU want to do, as that is what is destroying you. -Do NOT take extra doses to work or out in your car, etc-- give the tabs to someone who cares about you and who is able to say no to you, and have them give them to you each morning-- two pills each morning ONLY-- no exceptions. If you don't do that because you don't want the inconvenience, then there is nothing anyone can do for you-- you have to be aware enough of the danger to do what it takes to stay clean. If you dose only in the AM, and distract yourself if you get cravings, eventually the cravings will go away. But you CANNOT take shortcuts, or think you are somehow 'unique' and don't need to follow the rules!

Her Note:

Wow, your bedside manner sucks! I get your point but insulting this addict makes it impossible for me to respect you. I read your arguments with another addict that said you were angry and personalized everything and now I believe it! I'm sorry I asked for your help. Clearly you have your own issues to contend with. I wish you well. Please dont bother responding, I'll delete anything further you have to say. Peace!


My Final Comment:


People who are getting an understanding of what addiction does to personality will recognize this dynamic. It used to bother me-- now I realize it is just addiction. But it does remind me that you really cannot help an addict until the addict is ready to be helped-- and if you try, you will often regret ever wasting your time.

JJ


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 Post subject:
PostPosted: Tue Jul 21, 2009 12:31 am 
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Dr. Junig,

I don't see why she got so upset about your response.

Sometimes I guess others just want to hear what they want to hear, and anything else is unacceptable.

What did she expect you to say? I'm willing to bet that any answer would be the wrong answer.

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 Post subject:
PostPosted: Tue Jul 21, 2009 1:05 am 
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What the heck did she think you were going to say? "Get to the nearest fax machine stat, and I'll send you a prescription for fentanyl?"

Maybe she interpreted the all caps part of your message as yelling, but I just read it as you putting emphasis on those statements. In any case, I can't even get my doctor to call me - I have to go into his office to see him - let alone give me his email address and expect him to write to me. But you try to help as many people as you can - even though they aren't your patients.

I thought the fact that you answered her at all indicated support for her. And your advice was good. She needs to talk to her doctor. And yes, I do see that messed-up addicty behavior you mentioned.

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 Post subject: Whacky
PostPosted: Tue Jul 21, 2009 2:38 pm 
Reading her response is very upsetting. As busy as you are, you still took the time to respond. This person isn't even a patient of yours! She really appreciated that, huh? Yeah, right. It's very obvious that she just is not ready.

Maybe she will read that exchange a few times, then when she truly hits the bottom, she will understand it.

Patrick


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PostPosted: Tue Jul 21, 2009 2:44 pm 
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Seems like she just wanted an argument and honestly, if you ask someone for help and then get upset when they try and give it to you I think it really is obviously the attitude of someone who just wants to keep using. I also can't figure out how she kept trying to compare Sub to Vicodan. I think I've mentioned it before but at my induction I hadn't taken an opiate in over 4 months and it was a completely different subjective experience for me than an opiate I'd abuse I was honestly even kind of subconciously hoping for some of the euphoric feelings but I was ultimately let down, thank goodness though. It really was more of just feeling ok not high, kind of like the feeling right before you start going into withdrawals where the euphoria has worn off but not feeling horrible yet or like at the end of my using oxy this last time it seemed like no matter how much I took I couldn't get high anymore it was just to feel normal. When my doc and I were trying to figure out the right daily dose for me I once jumped from 16mgs daily to 8 mgs daily and didn't notice a single difference in how I felt. People that make claims that they have withdrawals when tapering above 4mgs makes absolutely no sense to me it really just seems like they want to make Sub sound like just another opiate so they can avoid personal responsibility again. I've also noticed alot of people always wanting to blame their own personal problems on meds their taking and write it off as just a side effect although I suppose when everything is always someone elses fault that kind of logic works. I dunno maybe it's different for different people but I don't know how opiate addicts could manage to make a 30 script of Sub last 30 days if it was really abusable or why someone could experience all these side effects that I've never had (and I'm usually very prone to side effects) Anyways it's really sad that she'll continue suffering but can't help someone who obviously doesn't want help and seems to want to find reason to be angry at the world....

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 Post subject:
PostPosted: Tue Jul 21, 2009 3:05 pm 
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I will be honest, your response was not comforting, was not compassionate or understanding. There is a reason for that- the woman is addicted to opiates and in her mind you provided her with nothing she "wanted" to hear. You gave her the truth and she is not ready for it- plain and simple. Anything anyone says to her other than the tape playing in her head will be considered cruel, wrong, or just unacceptable.
There is a HUGE problem with Suboxone being prescribed by certain docotrs and that is that addiction recovery treatment is not mandatory with the prescription. I do not think anyone should be left to seek out counseling on their own, THEY ARE ADDICTED TO OPIATES!!!! These people are not capable of making rational choices towards recovery.They want a quick fix, and instant answer and that is what Suboxone provides. I am so sick of hearing stories like this woman's and other people's who want to know how to properly complete a Suboxone induction- Um hello! Is that not what the doctor prescribing this drug is supposed to do?? Oh- that's right- these types are buying Suboxone on the street.
People are just becoming more and more self absorbed everyday and it is really sad.

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 Post subject:
PostPosted: Thu Nov 19, 2009 3:08 pm 
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It was the disease talking. She didn't want to hear the truth. And your suggestions were spot on. She needs to stop re-dosing everyday and needs to start learning coping skills that will help her one day become completely sober and off the suboxone. At first, I thought I needed that evening dose. Everyday around 4 p.m., I would feel a slump or take it before my evening shift for added motivation. Soon, redosing and taking it twice a day was not an economically viable situation. So I weened myself down from 16mg down to 6mg, once a day dosing (in the morning). Now, I do not feel the need to take more in the afternoons and don't even think about it much. My life is no longer consumed with getting drugs or thinking about drugs too much. These things do take time, and suboxone can be used to help these feelings. I knew a girl who went to my doc and also was in NA with me. In the beginning, she was taking 3 8mg a day and I told her that her need to redose was addict behavior. She even asked me for a few of mine so she could make it to her next appt. Now, she's on one a day and doing fantastic. Redosing or needle fetishes are often the downfall to those in the beginning. Once your life normalizes on Suboxone, you forget about these habits and start living life again on it's terms, not yours.


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PostPosted: Sun Aug 07, 2011 2:22 pm 
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Diary of a Quitter wrote:
What the heck did she think you were going to say? "Get to the nearest fax machine stat, and I'll send you a prescription for fentanyl?"



I lol'd.


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PostPosted: Mon Aug 08, 2011 9:49 am 
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if i was here family'. i would give her tuff love. i would say stop this your killing your self. doc junig was just giving her very needed tuff love and caring that she needs right now!! don't they do this type of treatment on the TV show INTERVENTION?


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PostPosted: Thu Aug 25, 2011 12:37 pm 
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She uses lots of AA speak and refers to herself as "this addict". I find that really sad that she has chosen to define herself this way. One of my major problem with the 12 steps is the stone cold belief that the 12 steps are prefect and infallible, which is not true. It only works for a small segment of the population (good for them if it does). Plus many (at least in my experience) are opposed to medication (especially subs and methadone) and some are even opposed to therapy ("you only need god, your sponsor and the program").

Notice how she is "too ashamed" to write or tell anyone? Supposedly you are supposed to have "total honesty" with your sponsor. I never could get comfortable with that, I didn't think my medication was for anyone else to judge, well except for my doctor. So now she is walking around in shame, knowing that she has relapsed, but cannot tell anyone. It seems like this is making the situation worse for her and easier to revert to denial.

She cannot take any criticism and is trying to put all the blame on Suboxone, rather than herself. Why is she the exception? She gets to take Subs whenever she wants, but other people who dosed multiple times daily seem to be able to be just fine with one or two doses. At least you tried Dr. J, seems like she has a long way to go.


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 Post subject: 12 Steps
PostPosted: Thu Aug 25, 2011 5:13 pm 
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Stephent,

I am going to take exception to your statement of the 12 steps are perfect and infallible. It clearly states in the Big Book of AA that all of the program is only a suggestion and that they don't have all the answers. Nowhere does it make that statement.

But I do know where you got it from. The member themselves. There are so many "old timers" that have opinions set in stone and no one can disagree with them. That was one of the reasons I left most of the meetings. I still go but it's hard to find a group which doesn't harbor some kind of preconceived "I know it all" attitude. There are many good people there who follow the Big Book the way it's supposed to be followed. Plus, you just take what you need and leave the rest behind.

I just felt some clarification needed to be posted so any newcomers wouldn't be put off going to a meeting. It's not for everyone, but it surely saved my life.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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