Thank you for the light in the morning when I walk the dog. This morning the sky was blue and the crocuses have returned. I’ve seen daffodils and now the neighbours tulip stalks are up. I’m so looking forward to the tulip days to come. It’s like somehow this year I lost faith in the fall and winter coming to an end. My brother’s diagnosis has brought me face to face with aging. I’m seeing illness all about me in a way that I’ve not for so many years. There’s always been the itching sensations after treating the scabies patients. The germophobias that assail me somedays. I know that I can’t go out from fear now some weekends. The attacks come back. There’s this lack of faith that I’ve had.
My decision to stop marijuana smoking as occasional as it was still remains an issue too because even though I drank and that was little compared to the mainstream today I felt I was wrong to be ‘breaking the law’ by smoking marijuana. As a professional it didn’t matter that I did this on holidays or weekends. It didn’t matter that I bought my marijuana from doctors or that I smoked marijuana with doctors , psychiatrists, psychologists, nurses and lawyers. It didn’t even matter that I had seen a psychiatrist who recommended that I smoke marijuana given my wife’s illness. All that didn’t sit well with me. Spiritually I’d felt that I wasn’t right. I’d made a promise to God to change my life. And I felt that smoking marijuana was breaking the law and I didn’t consciously break the law.
I was and am and always was a law abiding citizen for the most part even though in Canada today the legal system and bureaucrats and parliamentarians think people who are law abiding so called good citizens are fools, that’s what I was. I’d speed in my car occasionally but these were lapses of judgement. The marijauana smoking was conscious. I truly believed that the State was wrong, not just in it’s views of individual behaviour with respect to drugs but with its views towards sex and a variety of ’social laws’. As I got older I saw that Canada wasn’t a ‘free society’ in a lot of ways and when I smoked marijuana I was ‘rebelling’.
Yet here I was riding on roads made by the collective. I was enjoying the clean water and food that came from the collective. I was thankful for the courts and parliament for the jails and laws that fought murderers and thieves I enjoyed so much of what our ancestors had given us in our buildings schools and churches. I was being paid as a physician through the organization of health care. I was taught as a physician. These were all ‘lawful’. So what was I do ‘breaking the law’. Why was I smoking dope. I drank wine and that wasn’t an issue. I was a wine connoisseur. Yet when I drank wine I smoked cigarettes and marijuana. I’d concluded as a physician that smoking cigarettes was stupid, evil, extraordinarily unhealthy and that the tobacco boards were organized crime. I further thought that our government was corrupt to arrest marijuana smokers but allow tobacco producers to be rich and major influences on the supreme court and parliament.
When I drank legal alcohol I’d smoke again though I’d quit and when I was smoking cigarettes I’d prefer a joint so I’d break the law and get some marijuana as well. I’d even tried cocaine but was glad it didn’t agree with me. My pleasure seemed to be red wine and smoking a mix of low strength marijuana and tobaco. I thought I was ‘cool’ when I was a little buzzed. Like I was James Bond and Sherlock Holmes and that I could write and play guitar better. I was wrong . I also thought I was a better lover. I was slower but I don’t think I was a better lover. I know too I didn’t think about work and I didn’t worry and I was just happy to sit and let the world go round and round as compared to my normal state where I’m trying to help and work and concerned about what I could do next. I certainly never worried I wasn’t fulfilling my destiny or doing all I could be or achieving my potential or what others thought when I smoked a joint. I was utterly narcissistic and definitely purely pleasure oriented. A hedonist. Canada is a country of hedonism today or some might call it "shedonism'.
But I was breaking the law.
So when I stopped I sought help from the Physician Assistance program. I couldn't get my wife to address her illness so I felt the best way was for me to admit my problem, and that this would lead to her getting help. I was a politically outspoken person who had represented a lot of cases against the totalitarian corrupt authorities. I’d been an outspoken critic against communists and fascists and Canada breeds both in abundance in high places. I had integrity and told the truth and defended patients from abuses from above as much as I fought the diseases which plagued them from within. It made me a lot of enemies. Reporting a pedophie means that he’s caught but the ring survives. Reporting a doctor doing unauthorized experiments on patients for profits catching him but not the nest. Always the very authorities whose job it was to protect patients were collecting their pay and not doing their job. I was a vigilante good samaritan, doing the right thing. But of course, when the criminal was caught, it was naturally asked why the beurocrats who are paid millions to protect patients didn't get these 'big fish'. They naturally looked bad and they hated people like me. I think too that they're there to 'protect' those 'special doctors who aren't like the rest.
I had to do it . It was a thing I had with this ingrained integrity and ethics and morality that said that doctors shouldn't be killing and that eurocrats shouldnt be colluding. Of course everyone wondered who was getting kickbacks. Why were these doctors getting away with murder. The elite protects its own. It’s disgusting but true. To get ahead they have to have protection within the courts and high places and especially within the bureaucracy. I exposed this. If you do good in Canada you will be burnt. I was a whistleblower and whistleblowers are all collectively condemned in Canada. The State thrives on 'informants' and encourages 'confidential informants' and administrators carry little black books like all good communists do but 'whistleblowers' are another thing. They disrupt the common business of corruption and undermine the whole 'institution baksheesh' industry. The Reformer is the enemy of anyone who benefits from the status quo. The whole job of the elite, the bureaucracy and the courts is to resist change. Change threatens the powerful. The lie is they are always 'promoting change' deceitfully. Lie, lie, lie! Deny. Deny Deny! It's the halcyon cry of the courts and bureaucracy. Fuddle Duck!!!
I cause change. My generation was a ‘change catalyst.’
My question at the time is what do I do with my drug addicted wife and how can we get help with our marriage. I’d been divorced and concluded that I was facing another divorce and the common ingredient in my divorces was that my wives and I drank and smoked marijuana. Of course given feminism in it’s day and the radical feminists in beaurocracy they had long concluded that all divorce was the cause of men, another common ingredient in marriage, so drugs were irrelevant. This was before lesbian marriage with its similar rate of divorce so the idea that men were the cause of divorce went out the window but too late for my marriage. I divorced. I was punished as men are in divorce . It's a sexist society, i.e. men are sexist. I was also punished as marijuana smokers were in the day. Marijuana smoking wasn't actually punished but rather being truthful about marijuana smoking. The same as homosexuality. For the longest time homosexuality wasn't punished as long as you were not truthful about it. Society is that kind of lie. I was punished because while the bureaucracy paid lip service to the idea of ‘disease’ the individuals involved in the programs were holier than thou and claimed that they were the guardians of the public good.
Yet they didn’t care that the prime minister was smoking dope as a teacher and that the prime minister was smoking dope as an MP. They didn't about the irreparable damage he did as a teacher and the irreparable damage his example has had on children. Baseball players and hockey players are condemned for smoking marijuana because they are an 'example' to children but Justin Trudeau was smoking marijuana when he was an Member of Parliament so what kind of example does that set for children.
They justified all that they did to me and others by the idea that we were a threat to society. I was never a threat to society and never made a bad decision. I loved the movie with Denzil Washington as the pilot because that’s what I saw in my case and for those around me. This horrible ‘war on drugs’ world was coupled with beaurocratic pomposity and deceit.
So my marriage ended.
The friends of the men whose friends I’d caught stealing, killing and raping, suddenly gloatingly became my superiors holding my freedom in their hands. I was terrorized by a little hitler and his little eva brawn. And today I’m afraid of drugs because I believe seriously that too many people in Canada are on drugs and that the only way we have been able to get another lying Trudeau in leadership is because Canada is a nation of stoned drunks. I would have voted Trudeau when I was smoking dope.
So I’ve not handled the election well. I’ve not handled watching 18 billion candian dollars go to the PARTY. I’ve not handled the lies well and the idea that others don’t ‘get’ it. I’ve also wanted desperately to smoke dope again so I can join the stupidity and not be aware of what’s happening. I’d like to smoke dope and believe that there isn’t illness and everything is an illusion and that if I just have my dope mind I’ll get by. When I smoked dope it was like I was one of the batteries in the movie Matrix. I thought the Matrix was the best movies about the drugged and the awake.
I’m awake today.It's hard to be awake. I think of the millions who were not caught up in the Hitlermania of their day or the Lenninmania of their day. There's this 'mania', an orgy that I could get myself caught up in when I was smoking dope and drinking. I liked the group grope and hedonistic throb of the club scene when I was a little high and in denial of reality. I loved the escape to adolescence, the disregard and animal like awareness that drugs brought. I smoked a joint and drank some wine and I was blatto. My IQ dropped and I had trouble following conversations or walking to the bathroom. I was demented. Usually I was actually more aware than the thousand or so others in the club since I was only a light user in public and at home I used to just go to bed early. I was a happy drunk, if drunk is the right word. Rarely was I angry but like all couples drinking we had our shouting matches. She was always a public ranter screaming at me when I wanted to get her home public scenes worked well for women. I remember trying to get drunk women into taxis to get them home with even drunker men trying to keep them at parties and me caught between these two drunken nightmares. Sometimes I went home alone and worried all night if she'd get home somehow. When I went to Al Anon I was the 'wife' and my stories were the norm for that group. I fit right in. They'd all been their with their drunks and addicts. And yes, some of them had joined in but the fact was we'd always been the 'adults'. We'd been the ones who had to 'get the other home' or take care of the 'adult' business the next day. I was always 'papa'. I am seriously tired of being the 'man' . I always knew I could take care of myself and I could take care of others but that if there was trouble I really couldn't rely on the wife to take care of me. She was hardly able to take care of herself. It wasn't just out in the wilderness but in the city. I've watched the new rage of girls in high heels beating up guys in tv movies and it's more of the lie. I've known too many situations where there's three or four men and I'm defending myself and a woman and the woman is usually drunk and stoned and often caused this scenario but probably won't remember what happened the next day. Or she'll rewrite the script to be something like a Supergirl scenario and ultimately she'd find a way to blame me for her drunkeness or being stoned legless.
I’m thankful fortmy sobriety. I’m thankful I’m not stoned. I’m grateful for the relationship i have with family and true friends and the journey I’ve been on if only because it helps me related to the horrendous abuse that so many Canadians have had who when they smoked dope at their jobs were subjected to forced treatment for the benefit of society. I am thankful that Justin Trudeau driving his car stoned didn’t kill anyone and I didn’t kill anyone even though I now know that people who smoke dope are ‘impaired’ for 36 hours though they feel the effects of marijuana for only a few of those hours. I’m thankful I didn’t hurt anyone except my beautiful ex wife with my unkind words because her drug addiction was so much worse than anything I experienced and I never was understanding of her it mpairment because I was totally caught up in the narcissism that drugs does to self and relationships. I know today that relationships are the first thing harmed by drugs and that we can’t really know each other when we’re in a parallel play only because our only intimacy is with the ‘drug’.
I suspect there’s a ‘dose ‘ factor. I think there’s a ‘steady state’. Certainly pharmaceutical medications don’t ‘impair’ like ‘self administered pleasure’ drugs. I don’t suspect there is a ‘low dose’ that can be helpful but that this isn’t like the aspirin where we know the dosage by years of study. With marijuana it was always ‘good’ weed’ , bad’ weed’ and effects over time. I truly don’t think ‘maui wow’ was ever strong enough to do more than what a beer did but BC Bud is “killer weed’ far more potent than possibly cocaine or tequila. A regular hallucinogen. I hope one day that agents like SATIVEX will make dope safe.
But I’m struggling with this right now. When I hear Truedau speak I could swear he’s had a joint especially when he smirks to himself.
I loath that the Trudeau household was a Maggie filled dope house of second hand smoke when my friends were being put in jail for one joint. I hate the double standard and I’m really struggling with getting old and thinking I may be dependent on institutions like my parents were and have to trust again. Because I stopped trusting 17 years ago when I divorced and I witnessed the worst medical care I’d ever believed possible and saw first hand abuses of power that I never in my life would have thought could occur in Canada and yet were done to me. I’m lucky to be alive. God had other plans. I put my living down to the intervention of an unknown female Irish psychiatrist and some Christian doctors who believed in truth and love more than profit and power.
But I’m struggling. A whole PTSD time coming back to me and questions between me and God about prayer and faith and gratitude. And rumours of war and end days and Freud saying ‘maybe the paranoids are right’ and me thinking really ‘don’t sweat the small stuff’. And everyone seeming to be smiling their joint like smiles, while I’m standing on the street during “Invasion of the Body Snatchers’ scene. The smell of marijuana reeks. I can’t get away from it in Vancouver. It’s worse than the smell of second hand smoke or stale beer.
I'm hoping for tulips and that this too will pass. I'm hoping that with spring I'll snap out of this and find gratitude. I know I'm needing to deal with resentments and fears and that I have to get my head into the same room as my head. I've got to be thankful. I've got to find a way of seeing this present situation in a way that spiritually makes me a better person. I always remember Dr. Ney, the great anti abortion physician saying, the world is full of bitter people. You have choice. He'd cry when he heard of more babies being killed. I see the light going out in the eyes of people when they're on drugs and alcohol. He saw the light going out in the world when a baby was killed because there was no hope and no one cared for life. Death stalks the earth. But there is gratitude. And with an attitude of gratitude there is no room for the darkness, fear and resentment. That's what Hal Morley told me and Hal was a light in the darkness.
So again I must find gratitude. Thank you God that I'm alive. The daffodils are out. Soon the tulips will return.
Showing posts with label alcohol. Show all posts
Showing posts with label alcohol. Show all posts
Friday, February 26, 2016
Sunday, July 12, 2015
The Young Ones, (Bad Land: Road to Fury) movie
The Young Ones, directed by Jake Paltrow is a western science fiction movie released in 2014 but which just came out on Netflix. We watched this Irish South African production last night and really enjoyed the spaghetti western with a twist flavour. Placed in the future after a drought farmers struggle with the lack of water and the high cost of irrigation. I thought the movie was about the American Mid West. It has that John Steinbeck 30’s barrenness about it. Characterization is its strength. The young rebel without a cause character takes the old man with an achilles heal’s land and daughter. But his son sees through the deceit. A classic Western of the Louis L’Amour genre unfolds. It’s a Shakespearean plot. But the robot that replaces the donkey keeps the whole show grounded in the future. I loved the robot wagon. The injured mother is further able to walk because of modern robotic assistance. But the gun is an over and under, rifle and shot gun, not dissimilar to one I’ve owned myself. Laura and I were mesmerized by the movie, loving it to the inevitable but twisting intriguing end.
Nicholas Hoult plays Flem Lever the motorcycle riding woman’s man bad guy with a gift for character transformation like that of Jack Nicholson.. He starts out as a misguided youth and evolves to a truly psychopathic character whose reasoning and words are so believable yet not.
Elle Fanning plays the daughter, Mary Holms in a totally believable way. Early her character is so down to earth and adolescent it holds together the family that is spiralling out of control with events of the day. But her tour de force performance in the ending shows a grit as great as Nicole Kidman’s frontier women portrayals.
Michael Shannon plays the father Ernest Holm, whose achilles heel is alcohol. It’s cost his wife her legs but she still loves him deeply. It will be his undoing but he tries desperately to fight against this disease, his personal demon, in a quiet wholly believable way.
Aimee Mullins plays the mother Katherine Holms. Despite her invalidism and the futuristic high tech solution she comes across as almost saintly. Amazing personal actress.
Kodi Smit-McPhee plays the son Jerome Holm and is quite simply amazing. He is the movie. His characterization and transformation and Hitchcock surprise developments and twists make this a movie of all time. He is like a young Laurence Olivier or Richard Burton. A man for all seasons. Still waters run deep.
The rest of the cast were excellent and the unHollywood European pace was superb. The stark otherworldliness of Giles Nuttgens cinematography will probably haunt me.
Jake Paltrow is a great writer.
Nicholas Hoult plays Flem Lever the motorcycle riding woman’s man bad guy with a gift for character transformation like that of Jack Nicholson.. He starts out as a misguided youth and evolves to a truly psychopathic character whose reasoning and words are so believable yet not.
Elle Fanning plays the daughter, Mary Holms in a totally believable way. Early her character is so down to earth and adolescent it holds together the family that is spiralling out of control with events of the day. But her tour de force performance in the ending shows a grit as great as Nicole Kidman’s frontier women portrayals.
Michael Shannon plays the father Ernest Holm, whose achilles heel is alcohol. It’s cost his wife her legs but she still loves him deeply. It will be his undoing but he tries desperately to fight against this disease, his personal demon, in a quiet wholly believable way.
Aimee Mullins plays the mother Katherine Holms. Despite her invalidism and the futuristic high tech solution she comes across as almost saintly. Amazing personal actress.
Kodi Smit-McPhee plays the son Jerome Holm and is quite simply amazing. He is the movie. His characterization and transformation and Hitchcock surprise developments and twists make this a movie of all time. He is like a young Laurence Olivier or Richard Burton. A man for all seasons. Still waters run deep.
The rest of the cast were excellent and the unHollywood European pace was superb. The stark otherworldliness of Giles Nuttgens cinematography will probably haunt me.
Jake Paltrow is a great writer.
Thursday, January 23, 2014
Marijuana Smoker
I see addicts all the time. Mostly they come to me complaining of ‘depression’. More commonly than not they have seen a colleague of mine who has given them an antidepressant. The colleague has usually avoided asking any details about lifestyle and especially glossed over addiction.
Most medications were tested in non alcoholics and non addicts. If my colleague called the pharmaceutical company that made the drugs he prescribed they’d say they were not tested in combination with 2 bottles of wine a day or 1 to 6 joints a day of BC Bud. If there were justice, my colleague would be faulted for 'lack of due diligence'. All manner of patients have difficulties with combined pharmaceutical drugs and street drugs. It's a common cause of "side effects' and 'death'.
Most of my colleagues don’t know that Amsterdam after 40 years of experience with marijuania has lifted the standard famed ‘BC Bud’ marijuana to the most dangerous drug category, alongside Heroin and Cocaine. The Dutch 'experiment' with drugs has been a failure and is being reversed. Pot Cafe's are now highly regulated. Portugal decriminalized drugs but made treatment of addiction central. Everyone except Canadian Teen Agers and Children, are getting off drugs.
Most of my colleagues and Canadians in general seem ignorant that the marijuana that the Beattles smoked in the 60’s had a THC content of possibly 1 whereas todays BC Bud is as high as 15 to 30.
When a person comes into the office and says that they are irritable and having trouble sleeping and feeling negative and have self pity and negative ideations and maybe even are suicidal, the first thing I wonder is, are they drinking or doing drugs. My colleague would say, I think they’re depressed. Yet I was in charge of a suicide ward and was a supervisor in a psychiatric emergency and reviewed all the completed suicides I’d known and lo and behold they were almost all associated with drugs and alcohol.
Suicide is under almost all conditions a severe brain disease. If you see a mouse running repeatedly head first into a wall trying to kill it self you don’t at first consider Nietze and philosophical things. Even a veterinarian thinks, Brain Disease, meningitis, brain timor, etc.
So similar real doctors are taught when they see a person with symptoms, especially of depression, to think first a foremost of ‘organic’ causes, especially if the disease is so severe as to be ‘life threatening’ as suicide is.
Just as a person could have lung cancer without smoking almost all lung cancers especially the horrid oat cell carcinoma were found in tobacco smokers. My famous Califorinia respirologist friend says, 'there would simply be no department of respirology were it not for cigarette smokers'. We now learn that hypertension and heart disease are diet and alcohol diseases, diabetes most a diet disease. Once called mental illness, most departments now are called "Mental Illness and Addiction". There's less and less mental illness and more and more addiction but we can't 'blame the victim' and the rich doctors never tell the emperor he has no clothes.
Yet, just because depression is common and increasingly with the increasing drug (specifically marijuana) abuse and alcohol abuse, suicidality is ‘common’ .
But today patients who are diagnosed with addiction or alcoholism may face consequences.
1) They lose the ‘sympathy’ of the ‘depressed’ patient. “Just Say NO” campaign, while being true, and helping countless people, also minimized the difficulty that addicts and alcoholics have stopping drugs and alcohol.
Most people who have come to me with ‘depression’ and ‘alcohol or drug abuse’ have indeed tried to stop. The CAGE Screening Test, the simplest 4 question test of all, asks ‘have you ever considered cutting down’. Not surprising people who don't use or even don't abuse drugs and alcohol have never considered 'cutting down' but some 80% of those who have turn out to have the disease of addiction. It's a marvellous red flag.
Most patients referred to a specialist like me for depression who also have alcoholism or addiction have indeed ‘tried’ and are ‘defeated’. They have ‘hopelessness’ because their lives are ‘unmanageable’ with their addiction. Yet they don't like the name 'alcoholism' or 'addiction' and were 'alcoholics anonymous' called 'stress stop' they'd go their in a minute. It's just that 'honesty' is lost early in the addiction cycle, for the addict and alcoholic, and for the enablers and for society. Everyone avoids talking about the 'elephant in the room'. Especially if they've seen an angry elephant. Historically addicts and alcoholics excelled young in the navy and army early in their disease. The air force began to have a problem with addiction when they got into jets and today alcoholism and addiction are identified early in the military but very late in politicians and others farther from the 'front'. Artists rarely get diagnosed as alcoholics and whole generations of artists have been influenced by pedophiles, just as an example, likening sex with infants to an 'addiction' and showing how it can be promoted as 'okay' and 'normal' especially by 'addicted' artists. But when I asked marijuana smokers if they wanted their neurosurgeon on marijuania they said no. Today I prefer artists who aren't intoxicated. Tiny bubbles is very passé.
Chemical addictions, like alcohol and marijuana ‘short circuit’ and ‘disrupt’ neuropathways. It’s like splashing a circuit board with water. The computer screen will show all manner of entertainment and flashes and gibberish just like the ‘delirium’ state caused by intoxication.
Here I note, a person can have 1 to 3 glasses of wine without ‘intoxication’. Note the word ‘toxic’. Drug experience is ‘on or off’. One can drink without getting ‘drunk’ but one smokes marijuana and gets ‘stoned’ . Drug addiction is ‘digital’. It’s on or off.
The ‘state’ has been described as ‘dissociated’ , two personalities, and over time the ‘dissociated self’ can ‘consume’ the well person, in the Doctor Jeckyl/Mr Hyde way all of us see who work in addiction. Recovery is to a very large extent the recovery of the authentic self and the expansion of the potentiality. The addict person is a very abbreviated reduced person with limited access to higher brain function and major loss of control.
The ‘sympathy’ component of addiction was associated with traditional ‘disease’ categories. A person had a ‘heart attack’ and it was thought to be ‘involuntary’ whereas a person showed up drunk in the Emergency and that was ‘voluntary’.
The ‘rage’ in ‘pharmaceutical medicine’ is the treatment of ‘involuntary’ disease. Fundamentally there is ‘fate” and “free will”. In our society we ‘take credit’ for our good deeds and ‘blame’ others or the universe for the ‘negative’.
Insurance companies excluded alcoholism and addiction (because they could get away with it and knew they’d save fortunes in the insurance lottery) but kept ‘heart disease’ and ‘lung disease’ as ‘involuntary’. Today we know that those who had heart attacks and lung cancer more often than not got them as a consequence of drinking alcohol and smoking tobacco.
Today we call them ‘diseases of lifestyle’. Life ‘style’ is such a politically correct ‘fashion favourite’. In the Bible they said the ‘sins of the fathers and mothers will be passed on to their children’. In the East they called it ‘Karma’. But in Consumer Corporate society it’s just called “marketing’. More often than not my alcoholics had parents who were alcoholic and the smokers had parents who smoked.
But nobody wants to be ‘honest’ and no one including the doctors, government and corporations want to do anything but ‘collude with the dying customer’. Indeed when the smoker gets lung cancer the covert aggression of the manufacturer and friends was to offer him a cigarette. Alcoholics on their death bed are given more to drink. It’s comforting.
So my ‘johnny come lately’ junior colleague has a wholly ‘addiction’ practice so that only ‘addicted’ patients are sent to him. This ‘selection bias’ ensures that he not only doesn’t have to make the diagnosis he’s politically correct and leaves the heavy lifting to the first doctor who says, “I think your diagnosis is alcoholism or marijuania addiction."
The beauty of heroin addicts and crack addicts is that the ‘prohibition’ society makes everyone’s life easy because these people know what they are doing is ‘wrong’ and no one has to ‘convince’ them they have a heroin or crack addiction. They just may or may not be ready to address the problem. Drug addiction and alcoholism are ‘fun, fun and trouble and trouble.’ The sooner you get off the train bound for institutions, early death, disease, jails, the easier the fall, but as that train speeds up and descends deeper and deeper it’s more frightening to jump off and much harder to crawl back to where you are no longer down.
Chemicals such as alcohol and marijuana and eventually all drugs of addiction, which mostly over stimulate and damage the dopamine (happy, think ‘dopey’) circuits are ultimately depressing.
The initial euphoria is a product of the ‘disinhibition’ of the loss of the frontal lobes which are the latest and most human structure of the brain associated with judgement and editorializing, delayed gratification, planning.
The buzz diagnosis in the pharmaceutic industry for the 'mood swings' of addiction is 'Bipolar II" disorder. Addiction and alcoholism are the 'great chameleons of mental illness because ever 'symptom' of mental illness can be seen in the addict, from the usual 'anxiety' to the final states' early 'dementia' or 'schizophrenia' like' psychosis. All intoxications are 'delirium like 'or 'cognitive impairments' and 'mood disorders'.
Spiritual teachers recommended a once a lifetime or once a year ‘drug experience’ to have this experience of being aware of the more primitive ‘childlike’ thinking but especially the notion of ‘time’ as a critical factor of ‘assumed’ thinking. Meditation is a ‘timeless’ experience but so is ‘drug abuse’ and ‘drunkeness’. Immediately in the altered state one loses ‘time’ awareness. In the proper ‘context’, historically and culturally established by tribes and medicine men one could have an induced religious experience. This ‘dangerous’ rite of passage, as described in Huxley’s Perennial Philophy and known to Indians in the “Peyote” experience is wholly different from the ‘abuse’ of substances seen today. For one these 'religious drug experiences' are a cultural and community and 'controlled and regulated by elders 'experience. But mostly they are just 'once' or at most 'once' a year. There's nothing 'religious' or 'spiritual' about daily or weekly 'intoxication'.
It’s all in ‘dosage’. To the addict or alcoholic ‘more’ is better whereas in fact the value of alcohol to ‘enhance’ a meal as often encouraged by gourmands is at most a glass. Two glasses of wine ‘dulls’ the palate’ just as with the heart, which is made better with 1 glass of wine is made toxic with three. Huxley suggested it would be beneficial for people to have an hallucinogenic experience once in their life. Not to live their life as Mr Hyde.
Whereas alcohol biological effects wear off in a matter of days, marijuana or cannibis last weeks to months. A person’s perception and interaction with others, relationships being most sensitive to drug and alcohol abuse, as with higher tasks of work and play, are not just affected in the ‘intoxicated’ phase but also in the ‘withdrawal’ phase. Weekend binge drinkers are in ‘withdrawal’ in the middle and end of the week.
One wonders about jokes about being careful with work done by governments and union workers at the end of the week. The ‘withdrawal/craving’ cycle is all part of addiction. With the classic white collar martini drunk Judge his ‘decisions’ made late in the day were commonly less favourable as opposed to those mid day. Astute lawyers timed their clients cases against the judges daily evening drunkeness.
The WHO has long held that one is only clear of drugs and alcohol if one has been abstinent for one year. The DSMV says a person is in 'remission' if one is one year abstinent. All 'harm reduction' strategies are only 'valid' scientifically and culturally if they are leading and directed ultimately to 'abstinence.' Otherwise they may well be enabling, and a doctor takes an 'oath to do no harm'. Enabling is harmful. If one is only providing 'palliative care' one should indeed tell the patient that they are being treated as if there is 'no cure'. Abstinence is a 'cure' for addiction. So it's ironic that people are so often offered 'harm reduction' sometimes even first offered 'harm reduction' rather than given the true facts especially those that say that the people working in predominantly harm reduction are usually the most negative about their clients potential.
There is no ‘healthy’ or ‘medical’ smoke. All smoking is ‘unhealthy’ and ‘not medical’. When a person tells me they use ‘medical marijuana’ I routinely ask them if they ‘smoke’ it, knowing that the estimate that 95% of British Columbia ‘medical marijuana’ establishments were for pleasure purposes. Smoking marijuania is 'recreational use'. The cost/benefit medicinal value of any marijuana is negated by smoking it. Only marijuana consumed without smoking is potentially of 'medical benefit' given the burden of disease associated with marijuana.
2) The patient who has been diagnosed as having addiction or alcoholism is suddenly fased with not being told to take ‘a pill’ as alcoholics and addicts have been pharmaceutical industries greatest friends. The last alcoholic drug addict that died whose pill cabinet I went through, had every prescription and over the counter mood altering substance known to man. Indeed if one was cynical one would consider that the ‘drug doctors’ avoid asking about addiction with any care, concern or ‘due diligence’ because they know they run the risk of losing a very valuable customer. These ‘prescription pad’ doctors would rather throw another drug into the mental soup of the insane patient than ‘make the diagnosis’ of alcoholism and drug addiction because this could ‘anger’ the alcoholic and drug addict. Freud considered alcoholics and addicts to be 'orally addicted' He thought these people were fixated on the 'breast'. He thought the damage psychologically was done in the developmental phase when one is being 'weaned'. He was probably right. However sex addiction and gambling addiction are not oral fixations so addiction to alcohol and smoke might well follow Freuds observations but overall addiction appears more a behavioural disorder of impulse dyscontrol and regulation failure. Cognitive therapists see marijuana and alcohol as potentially like 'computer viruses'. We know now drug addiction and alcoholism are 'contagious' but better still we know that 'recovery' and 'abstinence from drugs and alcohol' are equally if not more 'contagious'. Groups get better whereas those who isolate are the least likely to recover.
Why doesn’t anyone want to ‘anger’ the alcoholic and drug addict? Ask a wife or husband what their response was when they told their partner they thought they were drinking too much or smoking too much marijuana. It's not usual a Rockwell moment. There's nothing cuddly about an addict or alcoholic who is questioned or even criticized. The whole development of the 'motivation' interview was to avoid questioning or even' addressing' the addict or alcoholic in the 'denial' phase of addiction. Alcoholics Anonymous told people to come when they reach their 'bottom'. A bottom could be anything from loss of marriage or loss of job or just feeling stupid on marijuana and having had 'enough' . It's said you can get off at any floor , you don't need to take the elevator all the way down.
Note, I have had a dozen complaints to the College of Physicians and Surgeons solely by making the correct diagnosis. I have had my car windows broken by alcoholics. Marijuana smokers have murdered my dog. My life has been threatened repeatedly and my windows have been shot out.
Judges, probably drunk, agreed that it was okay if a man killed another ‘under the influence’ , the courts being the prime enablers in the country for drug addiction and alcoholism and the best friend of the tobacco companies. Ask Mothers Against Drunk Drivers who their greatest enemy is. For years it was the judge and the courts. Doctors working against the widespread promotion and sale of tobacco especially to children literally fight the government and courts to stop the killing.
When I last diagnosed a marvellous old chap with alcoholism and refused to give him ‘valium’ for his ‘nerves’ and indeed told him the ‘combination’ was dangerous and that I couldn’t in good conscience prescribe him more drugs for his ‘anxiety disorder’ and ‘depression’, he wrote scathing ‘rate your doctor’ comments for 2 weeks after the visit. The difficulty with rate your doctor is that when I fired a secretary who had relapsed on crack she too wrote a number of ‘comments’ about my character, practice.
Alcoholics never say they don't want to go to alcoholics anonymous because they want to continue to drink. That would be a very politically incorrect thing to say to a boss, for instance. They always say they don't want to go 'because of the God thing'. That's because the 'god thing' works today. 30 years ago they said they didn't want to go because of fears of anonymity. My favourite complaint is that they don't like the colour of the wall. Everyone knows that Alcoholics Anonymous membership would sky rocket and be as popular as the pubs if they served alcohol. No one complains about picture of the Queen in the pubs and no one complains about drinking in Christian establishments and the very best drinking goes on at religious funerals.
I had one pothead complain that I was a man. They never said that I'd told them to quit pot. No one ever tells family what the doctor said truly when he tells them to stop watching porn, stop drinking or stop smoking pot. They tell the referring doctor if they're a woman, "I think I need to see a female psychiatrist'. If they're a man, 'they say I didn't like that psychiatrist, could you refer me to another'. The most popular psychiatrists prescribe the most clonazepam and ritalin to the addicts and alcoholics. They collude. Addicts and alcoholics love those who collude.Theres a great book called the Alcoholic Republic that gets down and dirty with the problem of collusion.
Alcoholics and addicts are nasty people in their disease. Dr. Jeckyl and Mr Hyde. They’re at first jolly but addiction is like making love to a gorilla, at first it might be cuddly but it’s not over till the gorilla says its over. So after the honeymoon the meanness of the addict or alcoholic comes on. And that’s any time but the increasingly briefer period of ‘okay’ feeling that the person gets with the abuse. The Chinese coined a term to describe searching for this elusive moment as ‘chasing the tail of the dragon’.
So the Government and the College and academics all spout ‘platitudes’ about not prescribing dangerous combinations of drugs with active alcohol or drug abuse( and there are countless measurement tools and assessment tools for assessing drug and alcohol abuse) but mostly people 'avoid' asking and 'cherry pick' and 'collude'. Everyone can then say they were 'well intentioned' even though the 'outcome measures' show this as often as not supports and even promotes'. It's a start though so better than nothing. Platitudes are sweet sounding at least. Like 'lifestyle disease'. Very PC. It’s not even easy to speak to a family member or friend about a person’s alcohol or drug abuse (given that the second question of the CAGE is ‘has anyone ever suggested you might have a problem with alcohol or drugs, has anyone "annoyed" you by suggesting you cut down). The Government and the Colleges of health care are by nature 'PEOPLE PLEASERS" so they are grossly in effective in addressing addiction because people with addiction (especially marijuana smokers) are so easily 'annoyed'.
Meanwhile the richest and most lauded and most successful psychiatrists are those who the drug companies reward for prescribing the most pills too. Addiction psychiatrists by their very nature, tell people to stop prescription drugs and abusing illicit drugs. We're poor by comparison and we're the ones who get the complaints not the 'drug pushers'. The police are beat up by the drunk, never the drug pushers. Drugs and alcohol impair the memory and protect the source. People rarely roll over on the drug pusher. Goddam the drug pusher!!!!
And today they tell people to stop smoking marijuana.
All doctors tell their patients that smoking mairjuania is unhealthy.
All doctors tell people to stop smoking.
Not very adamantly.
Not strongly.
But they're telling them.
I remember when we offered patients cigarettes in the office or bummed a cigarete from the patient or nurse in the hospital.
Addiction can be cured. Look at how addiction therapy has 'cured' smoking.
With all the gains we've made at high cost addressing tobacco smoke I'm sorry but I don't want to have the smoke epidemic start all over again with 'safe' 'herbal' 'medicinal' 'marijuana. Is every one stupid. Just look at the marketing of tobacco. It was sold as a means to have smaller easier deliveries because smokers babies were smaller. Women were encouraged by tobacco companies and their paid doctors to smoke during pregnancy.
Everything the marijuana crowd and their bully boys are saying is what the tobacco industry said 50 years ago.
But a day doesn’t go by in my office where someone smoking marijuana daily or weekly doesn’t tell me that I’ve got a problem suggesting they have a problem with marijuana.
Indeed any doctor who is being a healer in the western world of ‘lifestyle’ disease i.e. principal diseases are addiction diseases - gluttony i.e. over eating, smoking, over drinking, lack of exercise poor diet, workaholism etc, is going to get complaints.
Indeed when I ask doctors, have you had a complaint to the College of Physicians and Surgeons, and they say, “no’, I know that they are good businessmen, jolly good fellows, wearing rose coloured glasses, lying, playing it safe, but they’re not ‘healer’s and they’re not physicians in the true sense and they’re not ‘psychiatrist’ especially by any definition of the word. Or they have a very circumscribed practice where they can do medicine, like pathologists do, knowing all the ills of addiction but never having to face a living patient and tell them how to delay ending up in the morgue.
I'm PRO LIFE and condemned for it as a doctor today. The Euthanasia doctors and single government health care insurance with it's conflict of interest loves euthanasia. Euthanasia is good for you because it saves the government money.
First ‘do no harm’. The greatest harm that can be done other than actually killing a person is to watch, thereby, encourage, them, killing themselves. We call that ‘enabling’. Stop filming the terrorists. The media black outs of terrorist demands dramatically stopped terrorism campaigns of the 70's. Stopping advertising of tobacco stops it's sale. Stopping advertising marijuana and especially promoting 'safe heroin injection' ensures that there will be an eventual reduction in addiction. We are winning with stopping smoking tobacco. We have addressed the greatest public health concerns of the day. We are finding cures for HIV. To promote smoking today would be like say have promiscuous safe sex.
Yet so man individuals and most institutions in our society enable and encourage addiction.
It’s the elephant in the living room.
My friend who is one of the most successful and entertaining men in the field of gambling addiction gets millions of dollars of research money from the casinos and probably from the MOB. He laughs when he says his ‘mandate’ is not to ‘cure’ gambling but to find a way to ‘stop’ a gambler after he has lost his house, job and marriage, from coming to the casino and making a nuisance". His job is to address the ones who are bad for business. Indeed this genius recognizes that promotion of gambling is tied to the taxation system and may well be preferable to those who don't gamble as a means to fund bridge building. This doesn't say good things about the 'stigma' attached to addictions but it speaks to the reason why people want to be called 'stressed' or 'depressed' and diagnosed with 'PTSD" rather than "Addiction'.
No military doctor has ever advanced his career by suggesting that stupid military commanders shouldn’t waste their assets.
Indeed the most recent example of this was a brilliant loving caring wonderful human being of a military doctor who tried desperately to stop the wholly unnecessary ‘waste’ of ‘friendly fire’ only to be fined and pilloried by every official organization in the country. In my mind the man is one of the greatest heroes of the day and were our society not so sick , he’d be awarded the medal of honour for his courage and genius which surpasses mine and most of my colleagues.
Locally we have a ‘SAFER INJECTION Site” called “INSITE “ which I say should not be funded by ‘TAX PAYERS” but rather by the gangs like ‘allegedly’ the TONG and Hells Angels, who ‘allegedly’ are behind the distribution of heroin. Just like my gambling doctor friend the Insite crowd clean up the ‘mess’ caused by the addiction to Heroin. Insite makes Heroin look good, puts a pretty face on addiction and helps the gangs market their goods, protecting the industry of drug addiction just as my gambling friend is given money to stop the loser from returning to the casino when he’s lost his assets.
When I was a bar tend in England at 20 the pub owner threw the drunk without money out on the street. Now they call an ambulance. The cost of the health care system is exorbitant because of addiction.
10% of all people who abuse develop some level of addiction. Addiction is diagnosed by it's negative consequences at first to the individual and later to their society.
10% of marijuana smoker will develop addiction of some kind. The more available a substance is the exponentially higher rates of abuse occur. It’s not madness that had tobacco companies wanting to put cigarette dispensers in schools and it’s no surprise that the western world has an epidemic of obesity with all the carbohydrate ‘chips and nachos and chocolate dispensers’
Sabet in REEFER SANIETY shows very clearly that the taxes never pay the cost of addiction.
Indeed taxes are like the apocryphal proverbial Mexico City Police. When I was there I was told by locals if I was robbed I have to think twice about calling the police because they often apparently figured that since a ‘robbery’ had occurred and a gringo was putting in an insurance claim ‘anyway’ then they should help themselves to anything the thieves had forgotten to take. So the ‘taxation’ argument goes , since the ‘drug pushers’ have taken most of your money and life the government now can take whatever is left by ‘getting a cut of the action’.
Indeed in Canada in a famous referendum, all gambling and liquor and drug ‘revenue’ ‘sin tax’ was only to be allowed by government if the assets went directly only to health care and education because the corruption of government would occur when ‘sin tax’ went to the income of the politician and courts and bureaucrats. This is the case today which makes it hard for my patients to understand ‘what’s the difference between the RCMP arresting you and collecting tax for marijuana smoking” and the gangs charging you and beating you up a bit if you didn’t pay your debts.
A colleague psychiatrist, a favoured doctor-businessman, a great ‘corporate scion’ of medicine, says that the problem isn’t with heroin being sold on the street or cocaine being sold on the street or marijuana but rather that ‘we’re not selling it’. He sees no problem with ‘prescription drug addiction’ and indeed promotes speed, oxycontins and ativans and clonazepams better than any ‘street drug pusher’ I know. He doesn’t like the ‘competition’ which he sees as ‘unfair competition ‘ because the marijuania drug pushers ‘don’t pay taxes’ and ‘aren’t regulated by the College and Government’. Imagine the complaints department for The College of Marijuania Producers - every childs mother would be complaining daily to that place. But the College of Physicians and Surgeons is the enforcer of complaints by addicts about their doctors who have diagnosed their addiction with the negative consequences that has for their insurance or work or marriage. Stopping their addiction and getting in recovery would help everything especially their health but in the interim it's easier to complain and be nasty.
So Justin Troudeau says he smokes marijuana and smoked marijuana while working. Whats new about that. His father said he didn’t swear but said ‘fuddle duck’. The acorns don’t fall far from the tree.
But Clinton said he put a marijuan joint to his mouth and didn’t inhale and Obama said he smoked marijuana contritely.
The fact is, Clinton could well have done just what he said. When a joint is going around , to be part of the crowd, and to be a politician like Clinton became, you learn to ‘fit in’. You are kind of a Nazi among the Nazi’s and Kind of Communist among the Communists and Kind of a Jew among the Jews and Kind of a Christian among the Christians. This is the essence of political correctness. You are without ‘substance’ and as a new ‘opinion poll’ peace time politician you’re like the addled brained weak kings of the feudal world who had syphilis of the brain and were loved by all the powerful men until faced with an American Revolution. So Clinton caught in the act, with the photographic evidence, and testimony, not dissimilar to when he was caught with pants down, may or may not have ‘inhaled’ but he wasn’t ‘proud’ of his behaviour and tried like the marvellous Flashman of the Flashman novel series to weasel out of it. He knew right from wrong. Just like he knew it was wrong what he was doing on the job with Monica, his being married and collecting government funds for working but indeed was ‘distracted’ by Monica. We don’t hear much from her but Clinton today is the highest paid ‘speaker’.
Obama did drugs. He admits it and ‘apologizes’ for it. He ’s ‘contrite’. it's all in the attitude.
Justin Troudeau isn’t contrite. It's his attitude of entitlement that offends. That’s the problem. He ’s like Mayor Ford. They are two very entitled elitist white men who don’t seem to understand that this country is a ‘democracy’. We believe in laws for everyone. I'm waiting for an apology from Troudeau for breaking the law and essentially 'bragging' about it.
My friend got caught for smoking a joint. He went to jail. He didn’t like authority and was claustrophobic. 10 years later, raped and beatten and life changed irreparably he came out and joined a criminal gang. I met him years later. To the best of my knowledge he’d killed people by then. He’d been no different from me. We’d come from the same background. I smoked banana peels one day thinking it would get me high. He smoked ‘grass’. The police caught him. I got sick. He went to jail. I went to university. We met up in our 40’s. He deals marijuana.
I’m sure he thinks Justin Troudeau is a chump. He hates pompous poofs like the Troudeaus. Can’t stand them. To him they’re just feudal lords, ‘dandies’ is what he calls them. He reads a lot, was brilliant as a young man. Today he's rich. He could be the lead in Sons of Anarchy. He’s that sort of guy. He was only supposed to go to jail for ‘possession’ of marijuana. He was only supposed to do ‘6 months’.
Justin Troudeau wasn’t arrested for ‘possession’ and he would never have done time. As Animal Farm told us ‘some animals are more equal than others’. The communism of old man Troudeau, the great atheist religion, has turned out to have killed more millions in a mere hundred years than all the religious wars in the thousands of years before.
Communist countries have devolved into gangster run states and the democracy of Canada continues to muddle along despite the ubiquitous corruption of Quebec. The satire of the recent Quebec investigation, had one of the leading politicians of the province saying ‘I only took 5 million dollars, I could have taken millions more, everyone else was taking millions more’. That’s the moral relativism of this ‘class’ of characters. What might have been called in Casblanca, ‘todays’ cast of ‘usual suspects’.
My other patient was caught with a few joints and put in jail. He was young and blond and it was before the drug courts. So he was supposed to just do a few months and leave. He was gang raped and died of HIV Aids.
Everyone wants decriminalization. Decriminalzation makes the problem a health care problem and addiction and alcoholism ‘disease’. Legalization is what the gangs want. Already people like Emory are counting their millions. These pothead promoters are the new CEO’s of Tobacco Companies. They are addicted to power and money. No one cares about the addict. No one cares about the 10% - the losers.
The marijuiana smoker is toast.
Most medications were tested in non alcoholics and non addicts. If my colleague called the pharmaceutical company that made the drugs he prescribed they’d say they were not tested in combination with 2 bottles of wine a day or 1 to 6 joints a day of BC Bud. If there were justice, my colleague would be faulted for 'lack of due diligence'. All manner of patients have difficulties with combined pharmaceutical drugs and street drugs. It's a common cause of "side effects' and 'death'.
Most of my colleagues don’t know that Amsterdam after 40 years of experience with marijuania has lifted the standard famed ‘BC Bud’ marijuana to the most dangerous drug category, alongside Heroin and Cocaine. The Dutch 'experiment' with drugs has been a failure and is being reversed. Pot Cafe's are now highly regulated. Portugal decriminalized drugs but made treatment of addiction central. Everyone except Canadian Teen Agers and Children, are getting off drugs.
Most of my colleagues and Canadians in general seem ignorant that the marijuana that the Beattles smoked in the 60’s had a THC content of possibly 1 whereas todays BC Bud is as high as 15 to 30.
When a person comes into the office and says that they are irritable and having trouble sleeping and feeling negative and have self pity and negative ideations and maybe even are suicidal, the first thing I wonder is, are they drinking or doing drugs. My colleague would say, I think they’re depressed. Yet I was in charge of a suicide ward and was a supervisor in a psychiatric emergency and reviewed all the completed suicides I’d known and lo and behold they were almost all associated with drugs and alcohol.
Suicide is under almost all conditions a severe brain disease. If you see a mouse running repeatedly head first into a wall trying to kill it self you don’t at first consider Nietze and philosophical things. Even a veterinarian thinks, Brain Disease, meningitis, brain timor, etc.
So similar real doctors are taught when they see a person with symptoms, especially of depression, to think first a foremost of ‘organic’ causes, especially if the disease is so severe as to be ‘life threatening’ as suicide is.
Just as a person could have lung cancer without smoking almost all lung cancers especially the horrid oat cell carcinoma were found in tobacco smokers. My famous Califorinia respirologist friend says, 'there would simply be no department of respirology were it not for cigarette smokers'. We now learn that hypertension and heart disease are diet and alcohol diseases, diabetes most a diet disease. Once called mental illness, most departments now are called "Mental Illness and Addiction". There's less and less mental illness and more and more addiction but we can't 'blame the victim' and the rich doctors never tell the emperor he has no clothes.
Yet, just because depression is common and increasingly with the increasing drug (specifically marijuana) abuse and alcohol abuse, suicidality is ‘common’ .
But today patients who are diagnosed with addiction or alcoholism may face consequences.
1) They lose the ‘sympathy’ of the ‘depressed’ patient. “Just Say NO” campaign, while being true, and helping countless people, also minimized the difficulty that addicts and alcoholics have stopping drugs and alcohol.
Most people who have come to me with ‘depression’ and ‘alcohol or drug abuse’ have indeed tried to stop. The CAGE Screening Test, the simplest 4 question test of all, asks ‘have you ever considered cutting down’. Not surprising people who don't use or even don't abuse drugs and alcohol have never considered 'cutting down' but some 80% of those who have turn out to have the disease of addiction. It's a marvellous red flag.
Most patients referred to a specialist like me for depression who also have alcoholism or addiction have indeed ‘tried’ and are ‘defeated’. They have ‘hopelessness’ because their lives are ‘unmanageable’ with their addiction. Yet they don't like the name 'alcoholism' or 'addiction' and were 'alcoholics anonymous' called 'stress stop' they'd go their in a minute. It's just that 'honesty' is lost early in the addiction cycle, for the addict and alcoholic, and for the enablers and for society. Everyone avoids talking about the 'elephant in the room'. Especially if they've seen an angry elephant. Historically addicts and alcoholics excelled young in the navy and army early in their disease. The air force began to have a problem with addiction when they got into jets and today alcoholism and addiction are identified early in the military but very late in politicians and others farther from the 'front'. Artists rarely get diagnosed as alcoholics and whole generations of artists have been influenced by pedophiles, just as an example, likening sex with infants to an 'addiction' and showing how it can be promoted as 'okay' and 'normal' especially by 'addicted' artists. But when I asked marijuana smokers if they wanted their neurosurgeon on marijuania they said no. Today I prefer artists who aren't intoxicated. Tiny bubbles is very passé.
Chemical addictions, like alcohol and marijuana ‘short circuit’ and ‘disrupt’ neuropathways. It’s like splashing a circuit board with water. The computer screen will show all manner of entertainment and flashes and gibberish just like the ‘delirium’ state caused by intoxication.
Here I note, a person can have 1 to 3 glasses of wine without ‘intoxication’. Note the word ‘toxic’. Drug experience is ‘on or off’. One can drink without getting ‘drunk’ but one smokes marijuana and gets ‘stoned’ . Drug addiction is ‘digital’. It’s on or off.
The ‘state’ has been described as ‘dissociated’ , two personalities, and over time the ‘dissociated self’ can ‘consume’ the well person, in the Doctor Jeckyl/Mr Hyde way all of us see who work in addiction. Recovery is to a very large extent the recovery of the authentic self and the expansion of the potentiality. The addict person is a very abbreviated reduced person with limited access to higher brain function and major loss of control.
The ‘sympathy’ component of addiction was associated with traditional ‘disease’ categories. A person had a ‘heart attack’ and it was thought to be ‘involuntary’ whereas a person showed up drunk in the Emergency and that was ‘voluntary’.
The ‘rage’ in ‘pharmaceutical medicine’ is the treatment of ‘involuntary’ disease. Fundamentally there is ‘fate” and “free will”. In our society we ‘take credit’ for our good deeds and ‘blame’ others or the universe for the ‘negative’.
Insurance companies excluded alcoholism and addiction (because they could get away with it and knew they’d save fortunes in the insurance lottery) but kept ‘heart disease’ and ‘lung disease’ as ‘involuntary’. Today we know that those who had heart attacks and lung cancer more often than not got them as a consequence of drinking alcohol and smoking tobacco.
Today we call them ‘diseases of lifestyle’. Life ‘style’ is such a politically correct ‘fashion favourite’. In the Bible they said the ‘sins of the fathers and mothers will be passed on to their children’. In the East they called it ‘Karma’. But in Consumer Corporate society it’s just called “marketing’. More often than not my alcoholics had parents who were alcoholic and the smokers had parents who smoked.
But nobody wants to be ‘honest’ and no one including the doctors, government and corporations want to do anything but ‘collude with the dying customer’. Indeed when the smoker gets lung cancer the covert aggression of the manufacturer and friends was to offer him a cigarette. Alcoholics on their death bed are given more to drink. It’s comforting.
So my ‘johnny come lately’ junior colleague has a wholly ‘addiction’ practice so that only ‘addicted’ patients are sent to him. This ‘selection bias’ ensures that he not only doesn’t have to make the diagnosis he’s politically correct and leaves the heavy lifting to the first doctor who says, “I think your diagnosis is alcoholism or marijuania addiction."
The beauty of heroin addicts and crack addicts is that the ‘prohibition’ society makes everyone’s life easy because these people know what they are doing is ‘wrong’ and no one has to ‘convince’ them they have a heroin or crack addiction. They just may or may not be ready to address the problem. Drug addiction and alcoholism are ‘fun, fun and trouble and trouble.’ The sooner you get off the train bound for institutions, early death, disease, jails, the easier the fall, but as that train speeds up and descends deeper and deeper it’s more frightening to jump off and much harder to crawl back to where you are no longer down.
Chemicals such as alcohol and marijuana and eventually all drugs of addiction, which mostly over stimulate and damage the dopamine (happy, think ‘dopey’) circuits are ultimately depressing.
The initial euphoria is a product of the ‘disinhibition’ of the loss of the frontal lobes which are the latest and most human structure of the brain associated with judgement and editorializing, delayed gratification, planning.
The buzz diagnosis in the pharmaceutic industry for the 'mood swings' of addiction is 'Bipolar II" disorder. Addiction and alcoholism are the 'great chameleons of mental illness because ever 'symptom' of mental illness can be seen in the addict, from the usual 'anxiety' to the final states' early 'dementia' or 'schizophrenia' like' psychosis. All intoxications are 'delirium like 'or 'cognitive impairments' and 'mood disorders'.
Spiritual teachers recommended a once a lifetime or once a year ‘drug experience’ to have this experience of being aware of the more primitive ‘childlike’ thinking but especially the notion of ‘time’ as a critical factor of ‘assumed’ thinking. Meditation is a ‘timeless’ experience but so is ‘drug abuse’ and ‘drunkeness’. Immediately in the altered state one loses ‘time’ awareness. In the proper ‘context’, historically and culturally established by tribes and medicine men one could have an induced religious experience. This ‘dangerous’ rite of passage, as described in Huxley’s Perennial Philophy and known to Indians in the “Peyote” experience is wholly different from the ‘abuse’ of substances seen today. For one these 'religious drug experiences' are a cultural and community and 'controlled and regulated by elders 'experience. But mostly they are just 'once' or at most 'once' a year. There's nothing 'religious' or 'spiritual' about daily or weekly 'intoxication'.
It’s all in ‘dosage’. To the addict or alcoholic ‘more’ is better whereas in fact the value of alcohol to ‘enhance’ a meal as often encouraged by gourmands is at most a glass. Two glasses of wine ‘dulls’ the palate’ just as with the heart, which is made better with 1 glass of wine is made toxic with three. Huxley suggested it would be beneficial for people to have an hallucinogenic experience once in their life. Not to live their life as Mr Hyde.
Whereas alcohol biological effects wear off in a matter of days, marijuana or cannibis last weeks to months. A person’s perception and interaction with others, relationships being most sensitive to drug and alcohol abuse, as with higher tasks of work and play, are not just affected in the ‘intoxicated’ phase but also in the ‘withdrawal’ phase. Weekend binge drinkers are in ‘withdrawal’ in the middle and end of the week.
One wonders about jokes about being careful with work done by governments and union workers at the end of the week. The ‘withdrawal/craving’ cycle is all part of addiction. With the classic white collar martini drunk Judge his ‘decisions’ made late in the day were commonly less favourable as opposed to those mid day. Astute lawyers timed their clients cases against the judges daily evening drunkeness.
The WHO has long held that one is only clear of drugs and alcohol if one has been abstinent for one year. The DSMV says a person is in 'remission' if one is one year abstinent. All 'harm reduction' strategies are only 'valid' scientifically and culturally if they are leading and directed ultimately to 'abstinence.' Otherwise they may well be enabling, and a doctor takes an 'oath to do no harm'. Enabling is harmful. If one is only providing 'palliative care' one should indeed tell the patient that they are being treated as if there is 'no cure'. Abstinence is a 'cure' for addiction. So it's ironic that people are so often offered 'harm reduction' sometimes even first offered 'harm reduction' rather than given the true facts especially those that say that the people working in predominantly harm reduction are usually the most negative about their clients potential.
There is no ‘healthy’ or ‘medical’ smoke. All smoking is ‘unhealthy’ and ‘not medical’. When a person tells me they use ‘medical marijuana’ I routinely ask them if they ‘smoke’ it, knowing that the estimate that 95% of British Columbia ‘medical marijuana’ establishments were for pleasure purposes. Smoking marijuania is 'recreational use'. The cost/benefit medicinal value of any marijuana is negated by smoking it. Only marijuana consumed without smoking is potentially of 'medical benefit' given the burden of disease associated with marijuana.
2) The patient who has been diagnosed as having addiction or alcoholism is suddenly fased with not being told to take ‘a pill’ as alcoholics and addicts have been pharmaceutical industries greatest friends. The last alcoholic drug addict that died whose pill cabinet I went through, had every prescription and over the counter mood altering substance known to man. Indeed if one was cynical one would consider that the ‘drug doctors’ avoid asking about addiction with any care, concern or ‘due diligence’ because they know they run the risk of losing a very valuable customer. These ‘prescription pad’ doctors would rather throw another drug into the mental soup of the insane patient than ‘make the diagnosis’ of alcoholism and drug addiction because this could ‘anger’ the alcoholic and drug addict. Freud considered alcoholics and addicts to be 'orally addicted' He thought these people were fixated on the 'breast'. He thought the damage psychologically was done in the developmental phase when one is being 'weaned'. He was probably right. However sex addiction and gambling addiction are not oral fixations so addiction to alcohol and smoke might well follow Freuds observations but overall addiction appears more a behavioural disorder of impulse dyscontrol and regulation failure. Cognitive therapists see marijuana and alcohol as potentially like 'computer viruses'. We know now drug addiction and alcoholism are 'contagious' but better still we know that 'recovery' and 'abstinence from drugs and alcohol' are equally if not more 'contagious'. Groups get better whereas those who isolate are the least likely to recover.
Why doesn’t anyone want to ‘anger’ the alcoholic and drug addict? Ask a wife or husband what their response was when they told their partner they thought they were drinking too much or smoking too much marijuana. It's not usual a Rockwell moment. There's nothing cuddly about an addict or alcoholic who is questioned or even criticized. The whole development of the 'motivation' interview was to avoid questioning or even' addressing' the addict or alcoholic in the 'denial' phase of addiction. Alcoholics Anonymous told people to come when they reach their 'bottom'. A bottom could be anything from loss of marriage or loss of job or just feeling stupid on marijuana and having had 'enough' . It's said you can get off at any floor , you don't need to take the elevator all the way down.
Note, I have had a dozen complaints to the College of Physicians and Surgeons solely by making the correct diagnosis. I have had my car windows broken by alcoholics. Marijuana smokers have murdered my dog. My life has been threatened repeatedly and my windows have been shot out.
Judges, probably drunk, agreed that it was okay if a man killed another ‘under the influence’ , the courts being the prime enablers in the country for drug addiction and alcoholism and the best friend of the tobacco companies. Ask Mothers Against Drunk Drivers who their greatest enemy is. For years it was the judge and the courts. Doctors working against the widespread promotion and sale of tobacco especially to children literally fight the government and courts to stop the killing.
When I last diagnosed a marvellous old chap with alcoholism and refused to give him ‘valium’ for his ‘nerves’ and indeed told him the ‘combination’ was dangerous and that I couldn’t in good conscience prescribe him more drugs for his ‘anxiety disorder’ and ‘depression’, he wrote scathing ‘rate your doctor’ comments for 2 weeks after the visit. The difficulty with rate your doctor is that when I fired a secretary who had relapsed on crack she too wrote a number of ‘comments’ about my character, practice.
Alcoholics never say they don't want to go to alcoholics anonymous because they want to continue to drink. That would be a very politically incorrect thing to say to a boss, for instance. They always say they don't want to go 'because of the God thing'. That's because the 'god thing' works today. 30 years ago they said they didn't want to go because of fears of anonymity. My favourite complaint is that they don't like the colour of the wall. Everyone knows that Alcoholics Anonymous membership would sky rocket and be as popular as the pubs if they served alcohol. No one complains about picture of the Queen in the pubs and no one complains about drinking in Christian establishments and the very best drinking goes on at religious funerals.
I had one pothead complain that I was a man. They never said that I'd told them to quit pot. No one ever tells family what the doctor said truly when he tells them to stop watching porn, stop drinking or stop smoking pot. They tell the referring doctor if they're a woman, "I think I need to see a female psychiatrist'. If they're a man, 'they say I didn't like that psychiatrist, could you refer me to another'. The most popular psychiatrists prescribe the most clonazepam and ritalin to the addicts and alcoholics. They collude. Addicts and alcoholics love those who collude.Theres a great book called the Alcoholic Republic that gets down and dirty with the problem of collusion.
Alcoholics and addicts are nasty people in their disease. Dr. Jeckyl and Mr Hyde. They’re at first jolly but addiction is like making love to a gorilla, at first it might be cuddly but it’s not over till the gorilla says its over. So after the honeymoon the meanness of the addict or alcoholic comes on. And that’s any time but the increasingly briefer period of ‘okay’ feeling that the person gets with the abuse. The Chinese coined a term to describe searching for this elusive moment as ‘chasing the tail of the dragon’.
So the Government and the College and academics all spout ‘platitudes’ about not prescribing dangerous combinations of drugs with active alcohol or drug abuse( and there are countless measurement tools and assessment tools for assessing drug and alcohol abuse) but mostly people 'avoid' asking and 'cherry pick' and 'collude'. Everyone can then say they were 'well intentioned' even though the 'outcome measures' show this as often as not supports and even promotes'. It's a start though so better than nothing. Platitudes are sweet sounding at least. Like 'lifestyle disease'. Very PC. It’s not even easy to speak to a family member or friend about a person’s alcohol or drug abuse (given that the second question of the CAGE is ‘has anyone ever suggested you might have a problem with alcohol or drugs, has anyone "annoyed" you by suggesting you cut down). The Government and the Colleges of health care are by nature 'PEOPLE PLEASERS" so they are grossly in effective in addressing addiction because people with addiction (especially marijuana smokers) are so easily 'annoyed'.
Meanwhile the richest and most lauded and most successful psychiatrists are those who the drug companies reward for prescribing the most pills too. Addiction psychiatrists by their very nature, tell people to stop prescription drugs and abusing illicit drugs. We're poor by comparison and we're the ones who get the complaints not the 'drug pushers'. The police are beat up by the drunk, never the drug pushers. Drugs and alcohol impair the memory and protect the source. People rarely roll over on the drug pusher. Goddam the drug pusher!!!!
And today they tell people to stop smoking marijuana.
All doctors tell their patients that smoking mairjuania is unhealthy.
All doctors tell people to stop smoking.
Not very adamantly.
Not strongly.
But they're telling them.
I remember when we offered patients cigarettes in the office or bummed a cigarete from the patient or nurse in the hospital.
Addiction can be cured. Look at how addiction therapy has 'cured' smoking.
With all the gains we've made at high cost addressing tobacco smoke I'm sorry but I don't want to have the smoke epidemic start all over again with 'safe' 'herbal' 'medicinal' 'marijuana. Is every one stupid. Just look at the marketing of tobacco. It was sold as a means to have smaller easier deliveries because smokers babies were smaller. Women were encouraged by tobacco companies and their paid doctors to smoke during pregnancy.
Everything the marijuana crowd and their bully boys are saying is what the tobacco industry said 50 years ago.
But a day doesn’t go by in my office where someone smoking marijuana daily or weekly doesn’t tell me that I’ve got a problem suggesting they have a problem with marijuana.
Indeed any doctor who is being a healer in the western world of ‘lifestyle’ disease i.e. principal diseases are addiction diseases - gluttony i.e. over eating, smoking, over drinking, lack of exercise poor diet, workaholism etc, is going to get complaints.
Indeed when I ask doctors, have you had a complaint to the College of Physicians and Surgeons, and they say, “no’, I know that they are good businessmen, jolly good fellows, wearing rose coloured glasses, lying, playing it safe, but they’re not ‘healer’s and they’re not physicians in the true sense and they’re not ‘psychiatrist’ especially by any definition of the word. Or they have a very circumscribed practice where they can do medicine, like pathologists do, knowing all the ills of addiction but never having to face a living patient and tell them how to delay ending up in the morgue.
I'm PRO LIFE and condemned for it as a doctor today. The Euthanasia doctors and single government health care insurance with it's conflict of interest loves euthanasia. Euthanasia is good for you because it saves the government money.
First ‘do no harm’. The greatest harm that can be done other than actually killing a person is to watch, thereby, encourage, them, killing themselves. We call that ‘enabling’. Stop filming the terrorists. The media black outs of terrorist demands dramatically stopped terrorism campaigns of the 70's. Stopping advertising of tobacco stops it's sale. Stopping advertising marijuana and especially promoting 'safe heroin injection' ensures that there will be an eventual reduction in addiction. We are winning with stopping smoking tobacco. We have addressed the greatest public health concerns of the day. We are finding cures for HIV. To promote smoking today would be like say have promiscuous safe sex.
Yet so man individuals and most institutions in our society enable and encourage addiction.
It’s the elephant in the living room.
My friend who is one of the most successful and entertaining men in the field of gambling addiction gets millions of dollars of research money from the casinos and probably from the MOB. He laughs when he says his ‘mandate’ is not to ‘cure’ gambling but to find a way to ‘stop’ a gambler after he has lost his house, job and marriage, from coming to the casino and making a nuisance". His job is to address the ones who are bad for business. Indeed this genius recognizes that promotion of gambling is tied to the taxation system and may well be preferable to those who don't gamble as a means to fund bridge building. This doesn't say good things about the 'stigma' attached to addictions but it speaks to the reason why people want to be called 'stressed' or 'depressed' and diagnosed with 'PTSD" rather than "Addiction'.
No military doctor has ever advanced his career by suggesting that stupid military commanders shouldn’t waste their assets.
Indeed the most recent example of this was a brilliant loving caring wonderful human being of a military doctor who tried desperately to stop the wholly unnecessary ‘waste’ of ‘friendly fire’ only to be fined and pilloried by every official organization in the country. In my mind the man is one of the greatest heroes of the day and were our society not so sick , he’d be awarded the medal of honour for his courage and genius which surpasses mine and most of my colleagues.
Locally we have a ‘SAFER INJECTION Site” called “INSITE “ which I say should not be funded by ‘TAX PAYERS” but rather by the gangs like ‘allegedly’ the TONG and Hells Angels, who ‘allegedly’ are behind the distribution of heroin. Just like my gambling doctor friend the Insite crowd clean up the ‘mess’ caused by the addiction to Heroin. Insite makes Heroin look good, puts a pretty face on addiction and helps the gangs market their goods, protecting the industry of drug addiction just as my gambling friend is given money to stop the loser from returning to the casino when he’s lost his assets.
When I was a bar tend in England at 20 the pub owner threw the drunk without money out on the street. Now they call an ambulance. The cost of the health care system is exorbitant because of addiction.
10% of all people who abuse develop some level of addiction. Addiction is diagnosed by it's negative consequences at first to the individual and later to their society.
10% of marijuana smoker will develop addiction of some kind. The more available a substance is the exponentially higher rates of abuse occur. It’s not madness that had tobacco companies wanting to put cigarette dispensers in schools and it’s no surprise that the western world has an epidemic of obesity with all the carbohydrate ‘chips and nachos and chocolate dispensers’
Sabet in REEFER SANIETY shows very clearly that the taxes never pay the cost of addiction.
Indeed taxes are like the apocryphal proverbial Mexico City Police. When I was there I was told by locals if I was robbed I have to think twice about calling the police because they often apparently figured that since a ‘robbery’ had occurred and a gringo was putting in an insurance claim ‘anyway’ then they should help themselves to anything the thieves had forgotten to take. So the ‘taxation’ argument goes , since the ‘drug pushers’ have taken most of your money and life the government now can take whatever is left by ‘getting a cut of the action’.
Indeed in Canada in a famous referendum, all gambling and liquor and drug ‘revenue’ ‘sin tax’ was only to be allowed by government if the assets went directly only to health care and education because the corruption of government would occur when ‘sin tax’ went to the income of the politician and courts and bureaucrats. This is the case today which makes it hard for my patients to understand ‘what’s the difference between the RCMP arresting you and collecting tax for marijuana smoking” and the gangs charging you and beating you up a bit if you didn’t pay your debts.
A colleague psychiatrist, a favoured doctor-businessman, a great ‘corporate scion’ of medicine, says that the problem isn’t with heroin being sold on the street or cocaine being sold on the street or marijuana but rather that ‘we’re not selling it’. He sees no problem with ‘prescription drug addiction’ and indeed promotes speed, oxycontins and ativans and clonazepams better than any ‘street drug pusher’ I know. He doesn’t like the ‘competition’ which he sees as ‘unfair competition ‘ because the marijuania drug pushers ‘don’t pay taxes’ and ‘aren’t regulated by the College and Government’. Imagine the complaints department for The College of Marijuania Producers - every childs mother would be complaining daily to that place. But the College of Physicians and Surgeons is the enforcer of complaints by addicts about their doctors who have diagnosed their addiction with the negative consequences that has for their insurance or work or marriage. Stopping their addiction and getting in recovery would help everything especially their health but in the interim it's easier to complain and be nasty.
So Justin Troudeau says he smokes marijuana and smoked marijuana while working. Whats new about that. His father said he didn’t swear but said ‘fuddle duck’. The acorns don’t fall far from the tree.
But Clinton said he put a marijuan joint to his mouth and didn’t inhale and Obama said he smoked marijuana contritely.
The fact is, Clinton could well have done just what he said. When a joint is going around , to be part of the crowd, and to be a politician like Clinton became, you learn to ‘fit in’. You are kind of a Nazi among the Nazi’s and Kind of Communist among the Communists and Kind of a Jew among the Jews and Kind of a Christian among the Christians. This is the essence of political correctness. You are without ‘substance’ and as a new ‘opinion poll’ peace time politician you’re like the addled brained weak kings of the feudal world who had syphilis of the brain and were loved by all the powerful men until faced with an American Revolution. So Clinton caught in the act, with the photographic evidence, and testimony, not dissimilar to when he was caught with pants down, may or may not have ‘inhaled’ but he wasn’t ‘proud’ of his behaviour and tried like the marvellous Flashman of the Flashman novel series to weasel out of it. He knew right from wrong. Just like he knew it was wrong what he was doing on the job with Monica, his being married and collecting government funds for working but indeed was ‘distracted’ by Monica. We don’t hear much from her but Clinton today is the highest paid ‘speaker’.
Obama did drugs. He admits it and ‘apologizes’ for it. He ’s ‘contrite’. it's all in the attitude.
Justin Troudeau isn’t contrite. It's his attitude of entitlement that offends. That’s the problem. He ’s like Mayor Ford. They are two very entitled elitist white men who don’t seem to understand that this country is a ‘democracy’. We believe in laws for everyone. I'm waiting for an apology from Troudeau for breaking the law and essentially 'bragging' about it.
My friend got caught for smoking a joint. He went to jail. He didn’t like authority and was claustrophobic. 10 years later, raped and beatten and life changed irreparably he came out and joined a criminal gang. I met him years later. To the best of my knowledge he’d killed people by then. He’d been no different from me. We’d come from the same background. I smoked banana peels one day thinking it would get me high. He smoked ‘grass’. The police caught him. I got sick. He went to jail. I went to university. We met up in our 40’s. He deals marijuana.
I’m sure he thinks Justin Troudeau is a chump. He hates pompous poofs like the Troudeaus. Can’t stand them. To him they’re just feudal lords, ‘dandies’ is what he calls them. He reads a lot, was brilliant as a young man. Today he's rich. He could be the lead in Sons of Anarchy. He’s that sort of guy. He was only supposed to go to jail for ‘possession’ of marijuana. He was only supposed to do ‘6 months’.
Justin Troudeau wasn’t arrested for ‘possession’ and he would never have done time. As Animal Farm told us ‘some animals are more equal than others’. The communism of old man Troudeau, the great atheist religion, has turned out to have killed more millions in a mere hundred years than all the religious wars in the thousands of years before.
Communist countries have devolved into gangster run states and the democracy of Canada continues to muddle along despite the ubiquitous corruption of Quebec. The satire of the recent Quebec investigation, had one of the leading politicians of the province saying ‘I only took 5 million dollars, I could have taken millions more, everyone else was taking millions more’. That’s the moral relativism of this ‘class’ of characters. What might have been called in Casblanca, ‘todays’ cast of ‘usual suspects’.
My other patient was caught with a few joints and put in jail. He was young and blond and it was before the drug courts. So he was supposed to just do a few months and leave. He was gang raped and died of HIV Aids.
Everyone wants decriminalization. Decriminalzation makes the problem a health care problem and addiction and alcoholism ‘disease’. Legalization is what the gangs want. Already people like Emory are counting their millions. These pothead promoters are the new CEO’s of Tobacco Companies. They are addicted to power and money. No one cares about the addict. No one cares about the 10% - the losers.
The marijuiana smoker is toast.
Sunday, August 5, 2012
Pregnancy and Addiction - Dr. Stacy Seikel
Dr. Stacy Seikel ( http://stacyseikelmd.com/biography/) presented at the IDAA 2012 Medical Conference in Orlando Florida on the topic of Addiction and Pregnancy. Her slides were remarkable and her presentation one of the most informative and engaging presentations I've been priviledged to hear. Given the importance of her message regarding the future generation and the unborn child, universal screening is the very least that can be considered. The hundreds present were equally impressed given the level of applause. Dr. Seikel's work is not only cutting edge technologically but she had done amazing networking to ensure that women and families can access the treatments that are needed for the betterment of individuals and society. It was clear that she was motivated by a deep spiritual and ethical moral system of concern for pregnant women suffering from addiction. She demonstrated the compassion and empathy for these women who are so commonly ashamed and carry such stigma with their addiction when they simply can't say 'no' without the help of doctors and society when pregnant they want to change. Dr. Seikel is clearly there for her patients.
The following are the rough notes I took during the presentation with just a few highlights taken from many slides in which she simply wanted to point to one aspect of the problem or the solution. I was unable to get all the information but know that her slides and notes are available through the www.idaa.org. International Doctors in Alcoholics Anonymous was very fortunate indeed to have someone of Dr. Seikel's training, experience and high level of functioning in the system where it counts, most to come to the conference to present in the Continuing Medical Education in Addiction Medicine portion of the conference. I would strongly recommend her as one of the finest lecturers I've heard on a terribly important topic in our present day.
The following are the rough notes I took during the presentation with just a few highlights taken from many slides in which she simply wanted to point to one aspect of the problem or the solution. I was unable to get all the information but know that her slides and notes are available through the www.idaa.org. International Doctors in Alcoholics Anonymous was very fortunate indeed to have someone of Dr. Seikel's training, experience and high level of functioning in the system where it counts, most to come to the conference to present in the Continuing Medical Education in Addiction Medicine portion of the conference. I would strongly recommend her as one of the finest lecturers I've heard on a terribly important topic in our present day.
Pregnancy and Addiction
- Dr. Stacy Seikel
IDAA - Orlando - 2012
Prevalence
12 to 24% women use drug and alcohol during pregnancy
1 of every 3-4 women expose fetus to alcohol
Risk Factors
Family history of addiction
Experienced violence in childhood
Clues in medical history
No prenatal care
-fear of discovery of addiction
-secondary to general chaos in her life
Tattoos or self scarring
-seconary to IVDU or skin popping
Burns on hands and clothing
Positive hepatitis
Nicotine abuse
Screening
All pregnant women should be screened for drug and alcohol use
-T-Ace
-TWEAK
A positive test indicates need for a further evaluation
Elements of the history and physical may indicate need for drug screen
Immunoassay Drug Screens (not test)
- POC UDS = immunoassay
- semi quantitative immunoassay - not confirmation test
- lab screen UDS = immunoassay
- GCMS= Confirmation test
- LCMSMS = Confirmation test
- It’s important to know that a second immunoassay isn’t a ‘confirmation test’, must order a ‘confirmation test’ to know.
E-Forcse
Florida’s Prescription Drug Monitoring Program
PMP - shows every controlled substance prescribed and where from - helps get around the denial,
Patient advisory reports - used by the methadone maintenance program
We know that relapse is harmful to the fetus hence methadone is better.
Taper isn’t as good but will work with those who want a as a plan b.
Treatment Barriers
Fear, shame and guilt about use
-will she lose children if in treatment
-does she have family support
-attitudes of medical providers
Lack of comprehensive clinical care for all the problems of pregnancy and addiction
- can she get treatment? Transportation problems?
- Care is fragment
- lack of childcare in treatment
- basic needs must be met for her to engage in treatment
Co morbid diagnois impacting ability to access services
- multiple problems associated with co morbidity, ex psychiatric symptons
Alcohol
-known teratogen
-no safe level of drinking in pregnancy
New Alcohol Biomarker in cord blood
=3-4 week retrospective of alcohol use
Medical Complications of Drug Abuse in Pregnancy
Same as in regualar patients
Obstetrical complications of opiate abuse
-Polysubstance abuse is the norm
-increase in spontaneous abortion, esp first trimester
-amnionitis
-intrauterine growth retardation
-placental insufficiency
-postpartum hemorrhage
-preeclampsia, eclampsia
-premature labor/membrane ruptures
-septic thrombo
Opioid Dependence (DSM IV) Aka Addiction
Opioid Addiction
-chronic progressive, relapsing
-neurobiolgic changes
-pharmacologica treatments are effective in normalizing neurobiology
There is a big difference between short acting and long acting opiates.
- animal studies show long acting opiates can cause healing of the mu receptors which can go back to normal state
- brain makes new endorphins - so when I ‘m tapering off buprenorphines I encourage my patients to ‘go make endorphins’ - walk the dog, eat chocolate, take a bubble bath etc.
90 meetings in 90 days, is said in AA but it’s no coincidence because the first 90 days has so much healing that is going on.
Medication assisted treament is one option for people to engage in a treatment program to develop psychosocial skills to be able to tolerate a taper when they have some relapse prevention skills
Drug addiction is a brain disease
- prefrontal cortex mri studies show ‘disruption of brain circuits involved in reward and punishment’
- prefrontal cortex is the executive function
Morphine has a jack hammer on and off mu effect
- altered gene expression - you no longer are the person you were before you used drugs
- limbic system in overdrive
- prefrontal cortex not working
- “You have to use to survive”
-this is why a pregnant woman will use and she is so ashamed, because there’s nothing worse in her eyes and in the eyes of others than a woman who uses drugs
Because relapse is high in this population we have found maintaining women on methadone
Various Discipline see the Maternal Fetal Dyad differently
-obstetricians
-therapists
-addiction specialists
-psychaitrists
-pediatricians
-corrections officers
“Those in recovery who have themselves experienced loss of control will hopefully have some compassion for these women who get very little compassion from anyone else”
In Florida Orange County have developed an interdisciplinary program involving methadone treatment, hospital, high risk obstetric unit, outpatients and jail
Methadone and Pregnancy
-Methadone is only agonist therapy recognised for use in pregnancy, Supported by 30 years of research
Federal Laws Governing Addiction Treatment
-requires special federal license
-rules and rules and rules
Opiod agonist maintenance in pregnancy
- maintenance with methadone during pregnancy produces the same benefits as treatment in non pregnant
- The studies (Jones H, 2008) are really poor by evidence based medicine for taper because of the high risk of relapse. But if patient individually demands this despite the evidence against it, taper in second trimester - make sure though that there is no significant abstinence syndrome (Luty,J, Nilodeau V, Bearn J 2004)
Pregnancy patients receive all the same results methadone treatment programs for non pregnant
Clinical Study last year showed buprenorphine may have less abstinence but can have complications for c section
Methadone Induction
-start low - go slow
5 days until steady state obtained
- peaks 2-3 hour after dosing
- Consider dosing in office and observing patient for 3 hours
Opiate intolerant (or someone you’re not sure) Day 1 10-15 mg max
Opiate tolerant day 1 25 to 40 mg max
Increase every 5 days
The right dose throughout pregnancy is the dose that stops withdrawal
Buprenorphine
not fda approved, methadone gold standard in pregnancy but can be used and is widely used in Europe
NEJM Dec 2011 study
Suboxone can be changed directly to Subutex
Induction is very tricky because you are supposed to give suboxone when people are in withdrawn but this is contraindicated so while it can be done it’s
I don’t go from methadone to buprenorphine because of the withdrawal problems
Ongoing illicit or polysubstance use
Perioperative pain management for patients on buprenorphine
anesthetists need to know last dose,
-continue dose tid or qid (don’t stop because we must avoid withdrawal for fetus in pregnancy
-use non narcotic pain medications
-Fentanyl with it’s high affinity may over ride antagonist effect
With methadone in pregnancy dose once a day and realize post op may need 10 to 20% more narcotic because of pain
Discharge Pain Meds should be a fixed amount - tend to give ‘excess’ medications especially the post op patients who give too much - teen agers are dying from pills in medicine cabinet
Breast Feeding on Methadone
- it’s okay to breast feed - came from American Academy of Pediatrics
Thursday, November 24, 2011
Marijuana and Mental Health Controversy
The controversy surrounding marijuana as medicine has changed dramatically in the last 20 years. 20 years ago it was clearly 'illegal' and as such using it was evidence of 'addiction' as the risk/benefit ratio was so negatively weighted with potential incarceration and long term negative consequences of criminal record.
These days the 'value' of marijauana continues to be supported especially with newer pharmaceutical cannabinoids seeking approval every month. Further the federal Canadian political legislation has essentially 'decriminalized' marijuana by making it a 'medicine'. Even in California someone wanting to smoke marijuana just needs to create a disease category, present with symptons and go to the drive through marijuana clinics making millions with the new laxity of the laws there.
There is still no support for 'smoke' of any kind.
But there's really good evidence for it's benefit in spasms and chronic pain especially 'neuropathic' pain (nerve pain) and also with nausea. The benefits of the pharmaceutical components of standard marijuana are clearly outweighed by 'smoking', marijauna's dangers being essentially the same as tobacco smokers with chronic respiratory disease, cancer, asthma and heart disease associated with smoking. Smoking isn't good for you.
So marijuana cookies and tea are probably okay especially for Multiple Sclerosis and Nerve root pain in Diabetics. It was once the drug of choice for nausea in cancer treatment but better drugs have been developed. The trouble is marijuana 'users' want to 'smoke' it suggesting that the majority of such are using it not for intrinsic slow release 'medical value' but it's ability to cause a 'high'. Smoked marijuana is decidedly the route of choice for addicts.
Cesamet, Nabilone and Sativex are pharmaceutical cannabinoids. Cesamet is on the provincial formulary for chronic pain.
The difficulty though is that 'smoking' is an 'addictive' 'process'. This was seen with people given nicotine patches who smoked on top of that. It's the 'ritual'. Heroin addicts will 'shoot up' rather than 'smoke' heroin once they become addicted to the paraphernalia. There is a link between addiction and rapid access to brain of the compound.
But here's the controversy in mental health. The Diagnostic and Statistical Manual of the American Psychiatric Association describe clearly Cannibis (Marijuana) Induced Anxiety Disorder and Cannibis (Marijuana) Induced Psychosis. Bipolar II , the bipolar disorder associated with angry mood swings as opposed to Bipolar I where the mood swings are euphoria and depression, is the most common mood disorder in combination with addiction, clinically. It's no stretch to say that Cannibis Induced Mood Disorder is readily apparent too.
So how do you decided if the Anxiety Disorder is a product of marijuana use or helped by marijuana use. The subjective experience of alcoholics is that alcohol makes them calmer and less violent yet the overwhelming community experience and 'objective' experience is that this is simply not the case. There is indeed a benefit from one drink and even an alcoholic will be calmed initially by one drink as a marijuana smoker will describe a joint benefiting their anxiety for a half an hour. The anxiety that follows is worse though and with addiction there is increasing need for more substance with decreasing benefit.
Initially a marijuana joint might cause hours of 'calm' but in the addict a half hour is a good success. The alcoholic will get maybe 10 minutes of benefit from a shot when they're in withdrawal. Indeed the 'anxiety' and 'irritability 'seen in addiction is 'withdrawal.'
If you are using a substance that has caused the addiction to treat the anxiey which is the way the 'withdrawal' is experienced, then it's like pour gasoline on a fire. There's that briefest moment when the fire is 'doused' but after that the fire is clearly a whole lot worse.
As early as the 30's alcohol withdrawal was called 'restless, irritable, and discontent", "the RID's". Marijuana has been called 'marijuana maintenance' for those who mixed alcohol and marijuana or switched from alcohol to marijuana. Regardless the marijuana 'withdrawal' is experienced as the 'RID's" as well and lasts weeks if not months.
Drug seeking addicts will always tell me that they felt anxious off marijuana, alcohol or heroin in fact. The truth is that those who develop addiction had an underlying 'anxiety disorder' and were 'self medicating'. Normal people don't 'self medicate' and control the use of substances reasonably because they don't have the same underlying anxiety disorder.
Once an addiction is established it takes at least a year, some say 5 years, to be over the addiction. Seasons, 4 of them, seem to be associated with differing 'trigger's' for relapse. So 'recovery' is not considered to be 'weeks' or 'months' but rather 'years'.
So what to do when a marijuana smoker is 'bullying' and even 'threatening' you and definitely angry if their agenda is thwarted in any way, when they see the doctor and ask for his support in getting them the 'license' to smoke marijuana. It's said on the 'street' that 'good' doctors 'sign' and 'bad' doctors don't.
The government and it's regulatory bodies are all giving mixed messages but mostly their song is 'opinion poll' and 'cover your ass'. As usual, clinicians, like soldiers are on their own, damned if they do and damned if they don't but certain to be judged by "monday morning' quarter backs with sometimes years to mull over a decision the clinician must make in the 'real world 'of 'here and now."
I'm in the middle. I've definitely supported 'medical marijuana' for some patients and am wholly behind 'decriminalization' of drugs, drug court and yet I draw the line at full 'legalization' because it will increase the risk to those who are vulnerable and society at large will definitely have more traffic accidents and work accidents and psychiatric problems.
I'd like to be 'black or white' in this grey area. It's the same with benzodiazepine (valium type drug) prescriptions where patients who are addicted to marijauna, or alcohol or heroin say that the 'benzos' take the edge off.
My oath is 'do no harm' . In the short run there are 'benefits but in the long run I'm probably at risk of compounding the patients problems.
Each case I think is unique but the politics treat the world as a mass and certainly the marijuana promoters are 'recruiter's and have a 'conflict of interest'. I've none but it's a challenge and I thought it worth mentioning.
'
These days the 'value' of marijauana continues to be supported especially with newer pharmaceutical cannabinoids seeking approval every month. Further the federal Canadian political legislation has essentially 'decriminalized' marijuana by making it a 'medicine'. Even in California someone wanting to smoke marijuana just needs to create a disease category, present with symptons and go to the drive through marijuana clinics making millions with the new laxity of the laws there.
There is still no support for 'smoke' of any kind.
But there's really good evidence for it's benefit in spasms and chronic pain especially 'neuropathic' pain (nerve pain) and also with nausea. The benefits of the pharmaceutical components of standard marijuana are clearly outweighed by 'smoking', marijauna's dangers being essentially the same as tobacco smokers with chronic respiratory disease, cancer, asthma and heart disease associated with smoking. Smoking isn't good for you.
So marijuana cookies and tea are probably okay especially for Multiple Sclerosis and Nerve root pain in Diabetics. It was once the drug of choice for nausea in cancer treatment but better drugs have been developed. The trouble is marijuana 'users' want to 'smoke' it suggesting that the majority of such are using it not for intrinsic slow release 'medical value' but it's ability to cause a 'high'. Smoked marijuana is decidedly the route of choice for addicts.
Cesamet, Nabilone and Sativex are pharmaceutical cannabinoids. Cesamet is on the provincial formulary for chronic pain.
The difficulty though is that 'smoking' is an 'addictive' 'process'. This was seen with people given nicotine patches who smoked on top of that. It's the 'ritual'. Heroin addicts will 'shoot up' rather than 'smoke' heroin once they become addicted to the paraphernalia. There is a link between addiction and rapid access to brain of the compound.
But here's the controversy in mental health. The Diagnostic and Statistical Manual of the American Psychiatric Association describe clearly Cannibis (Marijuana) Induced Anxiety Disorder and Cannibis (Marijuana) Induced Psychosis. Bipolar II , the bipolar disorder associated with angry mood swings as opposed to Bipolar I where the mood swings are euphoria and depression, is the most common mood disorder in combination with addiction, clinically. It's no stretch to say that Cannibis Induced Mood Disorder is readily apparent too.
So how do you decided if the Anxiety Disorder is a product of marijuana use or helped by marijuana use. The subjective experience of alcoholics is that alcohol makes them calmer and less violent yet the overwhelming community experience and 'objective' experience is that this is simply not the case. There is indeed a benefit from one drink and even an alcoholic will be calmed initially by one drink as a marijuana smoker will describe a joint benefiting their anxiety for a half an hour. The anxiety that follows is worse though and with addiction there is increasing need for more substance with decreasing benefit.
Initially a marijuana joint might cause hours of 'calm' but in the addict a half hour is a good success. The alcoholic will get maybe 10 minutes of benefit from a shot when they're in withdrawal. Indeed the 'anxiety' and 'irritability 'seen in addiction is 'withdrawal.'
If you are using a substance that has caused the addiction to treat the anxiey which is the way the 'withdrawal' is experienced, then it's like pour gasoline on a fire. There's that briefest moment when the fire is 'doused' but after that the fire is clearly a whole lot worse.
As early as the 30's alcohol withdrawal was called 'restless, irritable, and discontent", "the RID's". Marijuana has been called 'marijuana maintenance' for those who mixed alcohol and marijuana or switched from alcohol to marijuana. Regardless the marijuana 'withdrawal' is experienced as the 'RID's" as well and lasts weeks if not months.
Drug seeking addicts will always tell me that they felt anxious off marijuana, alcohol or heroin in fact. The truth is that those who develop addiction had an underlying 'anxiety disorder' and were 'self medicating'. Normal people don't 'self medicate' and control the use of substances reasonably because they don't have the same underlying anxiety disorder.
Once an addiction is established it takes at least a year, some say 5 years, to be over the addiction. Seasons, 4 of them, seem to be associated with differing 'trigger's' for relapse. So 'recovery' is not considered to be 'weeks' or 'months' but rather 'years'.
So what to do when a marijuana smoker is 'bullying' and even 'threatening' you and definitely angry if their agenda is thwarted in any way, when they see the doctor and ask for his support in getting them the 'license' to smoke marijuana. It's said on the 'street' that 'good' doctors 'sign' and 'bad' doctors don't.
The government and it's regulatory bodies are all giving mixed messages but mostly their song is 'opinion poll' and 'cover your ass'. As usual, clinicians, like soldiers are on their own, damned if they do and damned if they don't but certain to be judged by "monday morning' quarter backs with sometimes years to mull over a decision the clinician must make in the 'real world 'of 'here and now."
I'm in the middle. I've definitely supported 'medical marijuana' for some patients and am wholly behind 'decriminalization' of drugs, drug court and yet I draw the line at full 'legalization' because it will increase the risk to those who are vulnerable and society at large will definitely have more traffic accidents and work accidents and psychiatric problems.
I'd like to be 'black or white' in this grey area. It's the same with benzodiazepine (valium type drug) prescriptions where patients who are addicted to marijauna, or alcohol or heroin say that the 'benzos' take the edge off.
My oath is 'do no harm' . In the short run there are 'benefits but in the long run I'm probably at risk of compounding the patients problems.
Each case I think is unique but the politics treat the world as a mass and certainly the marijuana promoters are 'recruiter's and have a 'conflict of interest'. I've none but it's a challenge and I thought it worth mentioning.
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