Hello again!

Well, I am certain that I'll blow my anonymity by discussing my odyssey - snap, I can't even say that much without betraying my identity, so instead, I think I'll start my exposition of the fates of my fellow addicts and alcoholics post-rehab.

Kathy (not her real name) is a nurse who was a patient during part of my tenure at Rehab (OK, I'm capitalizing it to mean MY SPECIFIC REHAB.) Kathy has two children, one who is relatively young, and she is an alcoholic. She left her two children at home with her mother in order to spend a month in rehab after a DUI. (All this in hopes of maintaining licensure.) I believe that her counselor in Rehab convinced her to contact her nursing advocacy group as a self-report, although a DUI would have been flagged when she reapplied for licensure.

Let's stop for just a moment to discuss this: how many DUI charges are made in the United States on a yearly basis? Yep, a lot. So, my question is: what professions outside of healthcare (and, ok, airline pilots) have to spend 20,000 dollars for 4 weeks of ineffective "treatment" that is defined primarily in spiritual terms? And, worst of all, is totally ineffective??? Who wrote that playbook? (ASAM? Yep, you're right!)

So, Kathy found herself in what the staff fondly described as "the ICU of addiction treatment." Did it help? A month away from her children, and more than $20,000 later, what happened to Kathy after she walked through the door of Rehab?

Spoiler alert! She relapsed, naturally, as did almost everyone (there is one exception) that I met while in Rehab. What does that say about Rehab??

Please  be rational and use your brain, rather than placing your trust in the collective wisdom. The collective wisdom has been molded by expediency. Read on.

When doctors get out of rehab, it's surprisingly difficult to get back to work in their original field of practice. This was even more true in the past, resulting in a lot of doctors with problems of addiction or alcoholism turning their talents to development of a field in which they could excel -  a field that they could dominate, as no one else really wanted to be associated with addicts and alcoholics. The American Society of Addiction Medicine was born of this marriage of convenience. Sadly, this self-proclaimed medical specialty is a victim of the "stinking thinking" that (apparently) characterizes the "disease of addiction."

BTW, is it even really a disease? For another column!

Back to Kathy. We'll just say that Kathy left her baby in the car when she got back from the store. And Kathy also hooked up with a guy she picked up on Okcupid, the day after leaving rehab (incidentally, it was the first day she went out with him.) The next day she hooked up with another guy she met on Match.com. So maybe rehab didn't work so well for Kathy, do you think?

Well, I'm talking to my BF. He is giving me a laundry list of what his neighbor is throwing off the balcony. A beach chair with Coors Light. A door. A television.

I had to repost this, from Kevinmd: it's on point.

A physician story of addiction and recovery

KEVIN | PHYSICIAN | DECEMBER 16, 2010

• 29
• Share on Facebook
• Share on Twitter

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober.  I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple.  It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either.  I know this will instantly raise the “denial” flag among the 12 steppers, and that is fine.

I hope it does because I want your attention and ear on this matter as well.  I am not in any denial about my addiction, but I flatly reject the notion that this is a terminal disease with but one cure: surrender and step work.  It’s such a complex issue that conveniently wrapping addiction into this package is ultimately fatal for some and may be leading to more relapse than “recovery” in others.

I don’t have data to prove it, and no one ever will, but I have seen firsthand examples of fatal failure and relapse while “working the steps.”  Sure, it could happen in any form of treatment, secular or otherwise.  And therein lies the crux of this conundrum for me: forcing and coercion of a unilateral mindset of treatment onto such a complex, misunderstood, and potentially fatal condition is at best bad medicine and at worst unethical and anti-Hippocratic.

However, as most things in life and (sadly) medicine, it comes down to the dollar.  Rehab is a multimillion dollar industry with the world’s most captive audience.  Usually professionals with no choice but to complete treatment at an approved facility or face public humiliation, loss of job and licensing, and potentially loss of career.  Over 90% of treatment facilities are 12 step based.  Most would argue, “well, it must work.”  I will counter with, “no, but it is a cookbook treatment that guarantees participation and hence profit.”  No one wants to be the first to criticize or go against conventional wisdom in such matters.  That would be financial suicide.

My journey into the world of rehab, recovery philosophies, and public perception has left me truly aghast.  Yes, I am a drug addict.  I became addicted to opiates and used them sporadically, then heavily, the last 3 years of a 15 year hellish trip.  When I was finally caught, I was grateful, though it was delayed.  I self-reported and started outpatient counseling and voluntary drug screens immediately and remained sober the entire time.  I was sent for an assessment at a well-known facility after meeting with my state board.  This is where the disillusion started.

There is basically no way a physician presenting for assessment will be told they don’t need inpatient care.  They have a truly captive audience and know it.  Admittedly, inpatient treatment was good for me, but for reasons cited below.  Through the months that followed I witnessed coercion and forced rehab more than once in substance abusers, not addicts.  I say I needed treatment, but retrospectively it was really the down time with fellow doctors that was therapeutic.  I never bought into their 12 step preachings.  It was so disappointing that an esteemed facility was basing it’s treatment on a mystical book of chants and simpleton sayings rooted in dogmatic preachings and faith healing with no science to support it.  It would be like getting into Harvard and finding your first textbook was a Dr. Suess story.

I also was, and am, incredibly disappointed in the lack of flexibility afforded physicians or even the general public when it comes to rehab.  It appears to be 12 step or nothing, and personally I think nothing is the better option between the two.  I was bombarded with the 12 step dogma, and it is a psychological beatdown designed to steal any control or free thinking one may have and force you into a program of pure religiosity dressed down as “spirituality”.  Submission is critical to their cause.  When agnostics are told their higher power can be a tree, I knew right away this had no basis in any science or fact and hence no merit.  I think tailoring treatment to the individual and not railroading all into the one size fits all treatment would be life saving.

Problem is, state boards don’t care.  They rubber stamp their approval on 12 steps because it’s cheap and easy.  If any other disease or behavior were treated this way the public backlash would be without precedent.  Addiction is a complex blend of behaviors and perhaps disease, but it in no way is a “terminal, fatal disease”.  That’s basically oversimplifying the workings of the most complex organ in the world.  Recent breakthroughs in neuroplasticity research are rewriting the books on how the brain can recover, rewire, and relearn.  Addiction may, in fact, be curable with the right treatment.  The right treatment is not blindly working some mystical Oxfordian steps that a couple of laymen came up with 80 years ago.  Why can we not be open minded and explore other options?

Personally, I do my own program of reading, some secular recovery, some SMART recovery, and mostly discussion with others.   I am mandated to 12 step meetings.  They are a huge waste of time, but I do write and think about alternative treatments during these meetings.  Anything to pass the time without being dumbed down and defeated.  When I was released from rehab, I was asked to do 90 meetings in 90 days.  I made it to around 70.

Retrospectively, I’m not sure how I ever did this other than to say I truly understand the Stockholm syndrome after being held as a 12 step captive for 3 months.  Now I like to say I am sober despite AA.  I also attend a monthly Caduceus group which is decent as it is colleagues,  but reality is it is just watered down AA.  What I believe is that my narcissistic and avoidant personality got a lot of pathologic positive feedback from a bad behavior and ultimately lead to addiction.  I think I have a minute, if any, amount of disease at work.  Once caught and shamed and then sentenced to 3 months of rehab, I had had enough negative feedback for a lifetime.  I had time to analyze this while in treatment and realized that the drug use had to be eliminated in order to never experience this again.  It was that simple.

Selfish endeavors had lead me to addiction, and if I was to ever be functional again, I had to eliminate the option to use, no matter what.  I am not in denial.  I know I can never use or drink again, even though I’m not an alcoholic because I am an addict and I don’t do any mind or mood altering substances in moderation.  I know that will never change, but it will also never be an issue because I am committed to lifelong sobriety.  I choose not to use because life is better without it.  I don’t have any using dreams, euphoric recall, cravings, compulsions, etc.  I have a great life now on the other side of my meltdown and that is all the positive feedback I’ll ever need to remain clean.  I have had several extreme marital and financial stressors  during and post rehab, and not once did I even entertain the idea to use.  I am also at least 30% more productive at work and that is huge for my positive feedback bank.

Submit a guest post and be heard.

JUST SAYIN'

So, after finishing my post, I thought I would wait to see if I had a test today, and if not, I would have a beer. Damn, selected for another test. FUCK THIS.

Houston, we've got a problem.

Tonight I went to my first Cadeucus meeting since I left rehab. Cadeucus gave me a format to tell the story I want to tell, so I'm excited to begin writing. There's a bit of backstory, but all will be revealed. The important thing about this blog is that it will allow me to tell the truth about things that people may want to understand, and that it will allow a forum for others in my situation, whether more or less, to discuss their experiences. Anonymously. Openly. With rigorous honesty. (Hat tip to P.)

I'm going to write about what I know. If you're reading this, and you've figured out who I am (you probably know me in the context of anonymity) be assured that I will neither violate your anonymity nor will I allow your stories to identify you. Your privacy is of paramount importance to me. I may tell your story, but I'll change the names, cities, drugs, and specialties.

So, I guess I will begin in the middle, as it took me a while to sit down and write after returning home. I was really glad I went to Cadeucus tonight, and I realized, as I told Suzy Q. about my brief relapse, that I have a problem. 

My entire medical career hinges upon abstinence. However, I am "not an alcoholic." My drug of choice (DOC) is any opiate. Preferably a pill, not injectable, but otherwise, any opiate. Any port in a storm . .  But given that I knew the possibility of being drug tested was real, I still had three glasses of wine after being told by the PHP that I would not be subject to a PETH test. The PETH test is an assay for phosphotidylethanol, a pathologic metabolite of alcohol that is used as a biomarker of heavy alcohol consumption. When you metabolize down the PETH pathway, the metabolite ends up in the membrane of a portion of your RBCs. The problem should be obvious, then - at that point, your metabolite must undergo degradation - or, in other words, you have to wait out the appropriate amount of time for destruction and erythrogenesis. 120 day life cycle. Hmmm. AND PETH is detectable at a limit of detection of 22 nm per liter. The half-life is a robust 4 days in whole blood, and the dried blood spot test offered by USDTL is stable for analysis to the same extent.

While performing initial calculations (after realizing that I would end up having the PETH test) I used studies based upon results obtained from HPLC analysis of PETH in blood. Well, the standard is now LCMS, and why would the PHP use anything else? It is exponentially more sensitive than the previous assay. 

My boyfriend is a genius chemist, and he calculated the likely result of my drinking escapade. Yep, he called to tell me I needed to donate blood, cut an artery and get a transfusion. That seemed pretty hard core, but I was unable to think of a way to adulterate the sample, which was eventually collected yesterday. This was after I donated 10% of my blood (HCT 39 to 33) AND after 12 days had passed. 

So, back to Cadeucus. Suzy Q. was kind enough to mention after the meeting that she had initially relapsed but it was not discovered (her DOC was an anxiolytic). She encouraged me to call her if I wanted to drink again, and like some of the other docs in attendance, her "problem" is not alcohol. Except that it is now one of our problems.

While in rehab, I feigned my "awakening," my St. Paul on the Road to Damascus experience: Yes, I can see how alcohol could BECOME a problem.

I wasn't sure if I believed it. I mean, yes, it could become a problem. To some extent, it was becoming a problem, although I don't drink to blackout or to get drunk. Now, however, I think it may be more of a problem than I realized, as I allowed myself to risk months of hard work and tens of thousands of dollars for three glasses of wine. I guess I am powerless over alcohol.

In the morning, I am going to a meeting and begin to search in haste for a temporary sponsor.