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I'm learning stuff here.
Thank you, to all.
Thank you, to all.
About maintenance, it is a step forward, and there are patients where you have to be wary of them being on it for too long. Like I said above, how to handle this becomes grey because there is no exact science on how long they should be on it. I have seen patients be on maintenance for over a year and appear to be sincere and have nothing I find wrong in terms of drug screens, maintaining interviews, etc. I see a group that doesn't want to take any steps forward in terms of getting off of it even afer being on it for months. That group makes me wonder. Like I said, I understand if one's scared to take the next step, but on the other hand someone is supplying the drug dealers.
10 years clean this year btw.
Wouldn't some of the above be an argument for methadone?
Isn't the evidence in regards to outcomes better for methadone ?
...What defines recovery? Satisfactory social and occupational functioning in the presence of continued maintenance? Sustained and full remission? I think the answer is not as simple as it seems.
maintenance on suboxone is not recovery.
So someone who is able to return to work, feel fulfilled there, reunite with family, manage their finances, avoid legal issues, and feel a return to their spiritual side as opposed to seeking the next hit isn't "in recovery" when they're taking suboxone, even when they had not been able to do any of the above with any consistency due to their addiction prior to such?
Because I've seen many do just that on suboxone.
I'm currently of the camp that says if ain't broke, don't fix it. And if it's running better than it ever has before, it ain't broke. I see no reason why long-term suboxone maintenance shouldn't be considered recovery when someone is taking a medication to treat disease that no longer runs their life and that instead they are leading the life they'd want to live.
Call it what you want, but if I were a patient, I know what I'd call it.
no, that patient is not in recovery. They may be doing well for them and it may be the best they can hope for....but it's not recovery. Suboxone is a harm reduction strategy. Not recovery.
10 years clean this year btw.
I'm currently of the camp that says if ain't broke, don't fix it.
So someone who is able to return to work, feel fulfilled there, reunite with family, manage their finances, avoid legal issues, and feel a return to their spiritual side as opposed to seeking the next hit isn't "in recovery" when they're taking suboxone
If I felt that way about psychiatry in general, I'd be giving a heck of a lot more benzos out and telling patients that are stabilized that they might as well forget about psychotherapy because if it ain't broke don't fix it.
Recovery implies they're at the end of the road in getting better.
Sneezing. didn't respond to your post.
All your points are ones I'm aware of, and I actually agree with you.
The question is not keeping patients on long term vs never ever doing so. IT will depend on each patient. I do think there are some merits for some patients with longer treatment.
But, as I said before, if someone wants to be on it, is doing well on it, and they just want to leave their treatment there, I don't like it, and from personal experience some of those people want to be on Suboxone for the wrong reasons.
One thing I like about this thread is there's no hard science or even from what I've seen debate on just how long someone should be on Suboxone.
And there's the holding the wolf by the ears problem. I've noticed that adopting that attitude allows some to slip through, wean themselves off and sell it. While Suboxone can help a patient tremendously, to simply give it out and think that's the best their going to get IMHO is wrong.
Recovery implies they're at the end of the road in getting better.
Your definition of addiction recovery adopts a very absolute and narrow view of what addiction really is. I recommend you take care of healthy patients that physically injure themselves after they slip on banana peels. In most cases, regardless of your interventions, you'll get close to 100% recovery and maybe a few good laughs while you're at it. You'll also get to use the word "real recovery" as much as you like around your colleagues and not have as many of them look at you with a jaundiced eye.
Recovery isn't a clinical term. It's something much more humanistic, and I would say it's not even in the realm of a psychiatrist's or a physician's duty to define it (we are in the fortunate position of being able to support our patients who participate in 12 steps, but we certainly aren't the ones who came up with it, and we're not the ones calling the shots). I think OPD's staff member's definition of the "process of putting the disease of addiction in a state of remission" is a lovely definition. There is no "end of the road" in getting better from addiction.
Some of this is a matter of politics, but addiction treatment has a set of politics that goes with it. Words matter because they affect thoughts, attitudes, and behaviors.
The generic statement "you're not in recovery if you're on opioid maintenance" is misguided. It may be true in some instances, but it may not be true in others.
yes words do mean things in the addiction community, and maintenance on a controlled substance is NOT recovery. It is harm reduction.
M
"In recovery, the goal is a contented life always achieved through progress, never perfection (which is unattainable)."
It also highlights that relapse is not complete failure.
Recovery isn't a clinical term. It's something much more humanistic, and I would say it's not even in the realm of a psychiatrist's or a physician's duty to define it (we are in the fortunate position of being able to support our patients who participate in 12 steps, but we certainly aren't the ones who came up with it, and we're not the ones calling the shots). I think OPD's staff member's definition of the "process of putting the disease of addiction in a state of remission" is a lovely definition. There is no "end of the road" in getting better from addiction.
Some of this is a matter of politics, but addiction treatment has a set of politics that goes with it. Words matter because they affect thoughts, attitudes, and behaviors.
The generic statement "you're not in recovery if you're on opioid maintenance" is misguided. It may be true in some instances, but it may not be true in others.
"Finally, it appears that only few of those presently
in recovery within the United States consider individuals
whose illicit opioid use is blocked by buprenorphine or
methadone to be in recovery (Murphy & Irwin, 1992; White
& Coon, 2003)"
Page 12:
"In NA this powerlessness is ascribed to addiction, rather than to a particular drug. In this
view, either the use of any mood-altering drug or the use of any medication to treat
addiction would be considered the antithesis of the first step: a continued effort at control
rather than surrender (We dreamed of finding a magic formula that would solve our
ultimate problemourselves.)
49 Through this lens any form of drug substitution and any
medication used to treat addiction is seen as one more effort at using a material
solutiona technological fixto solve what is at its core a spiritual problem (Our
experience indicates that medicine cannot cure our illness.
50)."
Why can't the endpoint of addiction be full remission, sayanara to all triggers, cravings, etc? I mean they weren't like this before using so why can't you go back to the way you were prior to starting?
I don't think it necessarily has to be dragged on and on and on. I am sure a few achieve this or come very close. In fact, I have a dear friend who was IV heroin user for many years and he is 8 years clean and has achieved this level of "sobriety." Its just not an issue anymore. Period.
I believe you can keep what you earn and never look back. I've seen it firsthand.
Congratulations. That's great.
It seems the members of AA and NA would generally agree more with the point of view that Suboxone is not recovery. As far as I know I think both groups don't have a centralized view on this subject. But I think this is a philosophical issue which shouldn't concern psychiatrists too much because our main task is to restore health and function to our patients and help them meet their goals, not to have them meet these philosophical guidelines.
What is recovery? A working definition from the Betty Ford Institute
specifically sections 5.1.2: Sobriety sustained by medications.
This seems to agree with the experiences I've had with people in the addiction community.
My treating Doctor worked on a system of three strikes you're out, so long as you were honest with him. If you lied about drug use, & got caught out by a random drug test, it was instant dismissal
Recovery isn't a clinical term. It's something much more humanistic, and I would say it's not even in the realm of a psychiatrist's or a physician's duty to define it (we are in the fortunate position of being able to support our patients who participate in 12 steps, but we certainly aren't the ones who came up with it, and we're not the ones calling the shots). I think OPD's staff member's definition of the "process of putting the disease of addiction in a state of remission" is a lovely definition. There is no "end of the road" in getting better from addiction.
Some of this is a matter of politics, but addiction treatment has a set of politics that goes with it. Words matter because they affect thoughts, attitudes, and behaviors.
The generic statement "you're not in recovery if you're on opioid maintenance" is misguided. It may be true in some instances, but it may not be true in others.
More recovery definitions from the experts:
"a sustained change in lifestyle"
"In recovery, the goal is a contented life always achieved through progress, never perfection (which is unattainable)."
"Embracing wellness through taking the required steps toward regaining health in the area in which one is recovering."
Again, despite vistaril's protestations, not inconsistent with Suboxone, in my practical experience.
Recovery is something defined by an indivual in terms of his or her own goals. Other than that, i hear a lot of normatization and execution of moral superiority by institutions of power. I dont think AA, manufacturers guidelines, the law, or even medicine can define it for a person (though they can define the terms of participating or being excluded from that institution).
Love these quotes, thanks. Question, are you asking about the substance using definition of recovery or the more general mental health use of the term that applies to living with illnesses such as schizophrenia etc (because the statements can very much apply to either)?
ummmm....that's pretty damn important. I mean what about the person whose "sustained change in lifestyle" was switching from shooting dilaudud to snorting oxy.......I suppose he can claim "recovery" as well.
Just personally I considered it recovery when I went from being on the streets, prostituting myself to pay for my Heroin habit to being in a stable, happy marriage, re-earning the respect of my friends and family, and looking at a return to gainful employment, Methadone or not.
I'm curious; have others had this experience?
I've heard one addiction specialist say that a little bit of Suboxone diversion might not be entirely bad, as he/she had experienced a number of patients who tried Suboxone for the first time on the streets and then decided to seek out a doctor to do maintenance. Kind of a, "This isn't so bad. I could quit using and take this," kind of a thing.
I'm curious; have others had this experience? Have others out there treating outpatients with opiate dependence had these situations occur?
Not taking this as direct medical advice, but Im an MS3 interested in psych. Plenty of my own time on the opposite side of the desk. But pertaining to this, what current strategies can anyone tell me about for fentanyl addiction. My mom, dad too i think still. And that obvious compounding factor of both them married
Need to formulate more of a concrete plan. Just saying to them or bringing up a shrink or detox isnt helpful
What kind of dosing schedules are recommended?
(sigh)
the fact of the matter is that medicine and psychiatry have very little to offer opiate addicts and alcoholics......we can detox them. then after that we can educate them and tell them they need to go to AA/NA.....but thats about the only way we can help
If you really believe that 12 step and detox is the only treatment for addiction and psychiatrists have no reason to understand neurologic diseases like epilepsy, I'm really starting to doubt you're a psychiatry resident at all.the fact of the matter is that medicine and psychiatry have very little to offer opiate addicts and alcoholics......we can detox them. then after that we can educate them and tell them they need to go to AA/NA.....but thats about the only way we can help
So on one hand you want us to believe your this super intellectual physician who went to a great medschool and great residency program, then on the other hand you believe detox and educating people to get them to NA/AA is the only viable role an addiction psychiatrist has to offer?
If you really believe that 12 step and detox is the only treatment for addiction and psychiatrists have no reason to understand neurologic diseases like epilepsy, I'm really starting to doubt you're a psychiatry resident at all.
This combined with all your other posts is enough for me to start to suspect a troll. Psych drop-out or never-ran? Medicine intern dumped by a psychiatrist SO? Scientologist? Many possibilities here...
If you really believe that 12 step and detox is the only treatment for addiction and psychiatrists have no reason to understand neurologic diseases like epilepsy, I'm really starting to doubt you're a psychiatry resident at all.
This combined with all your other posts is enough for me to start to suspect a troll.
Psych drop-out or never-ran? Medicine intern dumped by a psychiatrist SO? Scientologist? Many possibilities here...