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caring for those who wont help themselves (long post)

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14 years 11 months ago #63110 by docdocwhosthere
I've been shadowing one of my faculty who is our Chair of the Substance Abuse Medicine dept at my school. She's a pediatrician (of 17 yrs), and then did her fellowship in addiction medicine so she's double boarded in peds and substance abuse med. I've learned a lot...

... in shadowing in her practice and at the methadone clinic where she is director, what I find in her patients are stories of tremendously difficult and emotionally painful backgrounds. About 45% of addiction is genetic and ~55% is enviromental circumstances. That explains a lot in terms of who becomes addicted. This 16 yr old most likely has a strong genetic component coupled with a stressed family background, maybe physical, emotional or sexual abuse or neglect, maybe financial stress, maybe something else. She may have also had some pain trigger like a chronic physical problem or an emotional problem. Drugs in the ER might be what she seems to want, but what she needs is treatment by someone who really knows there stuff in addiction medicine. If you're in Brooklyn, there's gotta be someone around that you could consult with about her. If she's doing the opiod food group, she could benefit from methadone, suboxone, and bup (... just not all at once! :D ) Failing a board cert substance abuse doc, there's probably a IM/psych doc around who is interested in dual-diagnosis. And there's probably dual-diagnosis programs around too. H*ll, it's NY! There's got to be something there for her!

Here's a place where you could probably get a consulting doctor referal... www.amersa.com is the Assoc of Med Education and Reseach in Substance Abuse. It's a place to start.

Please remember that a patient like this that goes untreated is personally suffering a great deal, but can also cause a great deal of damage and suffering to others including her family and the public. While it's true that "you can lead a horse to water, but you can't make him drink", this patient is a minor and has been pregnant. An addictions doc is trained to "entice" a patient like her into treatment and then work on this young woman's life circumstances that have led her to addiction in the first place.

Hope that helps! These patients are tough, but treatable. Being judgemental of them will drive them away; engaging them in conversation about addiction and treatment works much better. Wish everyone here could be a fly on the wall in the clinic where I'm working! We've got over 100 patients who are in outpatient treatment and most are doing well. That's a lot of people who would otherwise be engaging in behaviors that are dangerous and illegal.

Hang in there! I know these patients are really challenging and the ER is not a good place for them (and understandably frustrating for you). Good luck!

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14 years 11 months ago #63111 by amy-k
If it were more than eight people would have survived the flood in Noah's time (not to make this a religious debate)

Too late... ;)

Look, I think you're making the same mistake a lot of people do when they themselves come out of very tough circumstances, clean themselves up, and are successful. You say, "If I could do it, anyone can, there's no excuses." Your mistake is to assume that everyone else has the same innate abilities that you did. That your story is the same as everyone else's. It isn't. You had strength -- you reached down, you found it, and it was appropriate to the crisis; that's great. But not everybody finds that kind of strength when they reach down, and it's the worst kind of cruel to tell them they're just lazy POS's when they're trying and can't make it.

Believe it: The world is not composed of you.

amyk

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14 years 11 months ago #63112 by amy-k
and thanks, docdocwhosthere, that was wonderful....

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