Archives for November, 2010

Addiction

A New Paradigm

I have described the epidemic of opioid dependence that has killed thousands of young people throughout the US over the past few years.  I’m sure that the claim sounds overstated, but during the past six years over a thousand people have died from overdose—mostly due to opioids—in Milwaukee County alone.

I have described the traditional approach to treating addiction, pointing out that for many years the treatment of the disease of drug dependence has...
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Addiction

It’s the Obsession, Silly!

It is important to understand the difference between physical dependence and addiction, two phrases that are sometimes used interchangably but that may or may not refer to the same thing, depending on the context.

Tolerance and withdrawal are signs of 'physical dependence' on a substance.  Addiction, on the other hand, is a complicated term that has different meanings in different contexts, but generally refers to an obsession or attachment to a behavior, person, or...
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Addiction

Buprenorphine and a Catch-22

Addicts in and out of treatment can face a frustrating 'catch-22’ * when confronted over whether they are in good recovery, or whether they are instead sliding in the wrong direction.

The dynamic is exemplified in sinister form in the movie One Flew Over the Cuckoo’s Nest; if a person is considered ‘insane,’ nothing the person says or does will prove his or her sanity.  In the case of addiction, every addict...
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Addiction

Something is Wrong Here– But Don’t Shoot the Messenger!

My third patient of the day today was Tom, a 22 year old young man who I’ve been seeing for the past four years for treatment of addiction to opioids. We started out the session by talking about how good things have been going in his life since starting buprenorphine, a medication that efficiently eliminates cravings for opioids and that has been available by prescription in the US since 2003.

For several years now,...
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Addiction

Addiction and Anger; Illness and Sympathy

According to the traditional paradigm, opioid addicts entering treatment leave detox after about a week, still experiencing a great deal of fatigue and depression but able (and expected) to participate in the various components of the treatment program.

The program where I was treated ten years ago was ‘open-ended,’ meaning that patients stayed in residential treatment until deemed ready to leave by their attending addictionologists. The average length...
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Addiction

Treating opioid dependence the ‘old fashioned way’

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...
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