My dad passed away two days ago, one day after his 89th birthday.  It doesn’t feel quite right to post something so personal.  But it feels more wrong to write about anything else.

Writing was a source of tension between us in some ways.  My perspectives on myself, my parents, and my upbringing have changed over the years, and I tried to share my observations with my dad in several short essays centered around memories from my childhood.  The efforts were a mistake.  I learned that insight develops in each of us at different rates and in different directions, and my ‘aha’ moments—realizations about how my dad shaped my development— felt to him like criticism.  I don’t think he fully realized that I accepted him, loved him, and respected him.

As for my ‘aha moments’, I don’t assume that my realizations and insights are accurate.  As my perceptions change over the years, I try to remain open to two alternate explanations for those changes—that with age I’ve learned, through wisdom, to see things more accurately, or that with age my thought process is becoming more rigid and any newfound ‘insight’ is an illusion, a product of that rigidity.

My dad was an intellectual, who read more books about philosophy and theology each year of his adult life than I’ve read in my lifetime.  So when our understandings of the world differed, I had to at least consider that my own judgment was off, rather than assume that old age impacted HIS judgment.

So to sort things through, I wrote.  I honestly thought that with enough effort, we would fully understand how we each see things; not that we would necessarily agree, but that we would fully understand each other’s perspective.  But I eventually decided that at least for us, differences in our individual perspectives ran too deep for us to completely understand each other— no matter how hard we tried.

My dad grew up during the depression, fought in Germany during WWII, became an attorney on the GI Bill, and worked for the Atomic Energy Commission before settling down in private practice …

I relapsed in 2000 after seven years of sobriety, and my attachment to opioids progressed much more rapidly than during my initial addiction.  I wrote a post a number of months ago that described ‘living on two levels,’ and that was my experience at the time—as if one part of my personality was frantically taking ever-increasing doses of dangerous narcotics while the other part, horrified, looked on.

Eventually my behavior caught the attention of enough people that I was confronted about my addiction.  I had been trying to stop using on my own for several months, but I argued over the need for residential treatment.  I remember sitting with the hospital CEO, babbling that I would be able to straighten myself up on my own if I had a few weeks of sick-time, and his response:  ‘Jeff, you have needle marks on your hands!’

I’ve shared my opinion that traditional treatment methods for opioid dependence—i.e. residential, usually step-based treatments—are a waste of limited resources.  I’ve written that relatively few opioid addicts successfully complete such treatments.  And many of those who ‘clean up well’ after two or three months die from relapse and overdose, months or years down the line.

Those who disagree with me sometimes pointedly ask “if getting clean without Suboxone is impossible, how did YOU do it?!” My usual answer is that my situation was and is very unique, and it would be misleading to compare my experience to that of most people.  But in case someone uses my experience to justify a similar path as mine, i.e. through residential treatment, I’ll expand on my answer.

This is part one of a three-part discussion about will power; look for the rest of the story next week, after the Packers beat the Bears in the NFC Conference Championship.

A person posted the following comments after one of my articles about Suboxone:

While Dr. Junig knows what he’s talking about, not everything he says is always true. Not everyone needs permanent blocker therapy. Everyone’s will power varies. The simple fact is, the worse withdrawal is, the more likely that person is to not want to go through it again, meaning abstinence. The easier withdrawals are, the more likely those persons’ mindset will be “one more can’t hurt”. Pain builds you; it builds character, personality, and maturity.

I have had my share of bad withdrawals, as have most opioid addicts who have lived with their illness for a few years.  Unfortunately there is much more to staying sober than remembering the pain of withdrawal.  There is also much more to staying clean than ‘character, personality, and maturity.’

When I mentioned in a prior post that outpatient treatment of opioid dependence is generally unsuccessful, I was referring to the results of the ‘old paradigm’ of treatment. Since 2003 new approaches, using new medications, have revitalized outpatient treatment efforts and spurred physicians– in the past, only bystanders of the treatment process– to become active members and even leaders of treatment efforts.

Before 2003, patients who eventually recognized defeat in their struggle with opioid dependence would enter residential treatment. The first stage of residential treatment consisted of ‘detox,’ a medically-based process usually performed in hospitals or in locked psychiatric wards. One purpose for detox was to help addicts as their bodies were cleared of the addictive substances, a process that usually results in varying severity of withdrawal symptoms, depending on the substance. Withdrawal from some substances, for example alcohol or benzodiazepines, can be life-threatening. Opioid withdrawal on the other hand is very unpleasant for the addict, but is not generally life-threatening. As the saying goes, opioid addicts in withdrawal only WISH they were dead!

The main role of detox for opioid addicts is to keep addicts away from opioids. Even after realizing that opioids are destroying their health, lives, families, occupations, and finances, most opioid addicts cannot stop taking them and continue to go to great lengths to get them. I have known physicians with medical licenses on the line, who knew that taking opioids again would mean losing the ability to practice medicine for the rest of their lives– who  returned to using and lost everything. When I worked for the prison system I had patients who were as innocent as anyone could be before their addiction to opioids, who robbed pharmacies, broke into homes, or became prostitutes in order to get opioids. I would never have completed my own detox in 2001 if not for the locks on the doors of the facility. Although by about four days of withdrawal, I was too weak to walk the length of the hall, spending what seemed like endless days with my limbs shaking involuntarily, my intestines in …

Doctors sometimes joke about how our medical specialties affect how we view the world.  When I was an anesthesiologist, I became more and more aware of ‘the airway,’ a collection of anatomical findings that predict whether a person is easy to intubate—the term for inserting a breathing tube into the trachea.

In anesthesia, securing the airway is the ultimate concern, and most anesthesia injuries occur from ‘losing the airway,’ leading to brain damage or death from hypoxia.  Airway assessment is an important part of an anesthesiologist’s pre-op assessment, and eventually becomes unconscious and automatic.