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.

Zombies

I’d been expecting the zombies all my life.  They used to be called Communists.  Before that Nazis.  Then we called them Squares. And after that Conservatives.  Church goers were zombies for a while.  Anyone who didn’t go to university and become an intellectual was obviously a zombie.  I just got around to knowing they were corporations later in life.  I figured they were police and jailers and politicians and judges.  Anyone other than what my group thought was okay had to be a  zombie.

There were always us and them.  Then it was just me and them.  Then I wondered if I was a zombie.  We become what we fear. I was mighty afraid of zombies.  So how come I wasn’t well.  Everyone around me was walking funny. They weren’t biting people but they were eating flesh in church and worshiping the killers in the wars.  Everyone was selling guns and drugs.  

I was ready for the zombies.  I wasn’t ready for my being one.  

Addiction Dialogues, West Vancouver

I was honored to be asked by David Berner to be apart of Addiction Dialogues.   A panel discussion would allow the community to discuss and answer the concerns of homeowners, citizens, parents, employers and others interested in what addiction is and what can be done about it at an individual, family, work and community level.
David Berner, Executive Director of the Drug Prevention Network of Canada, had founded the first residential treatment centre which began in Vancouver British Columbia as the X -Kalay foundation and continued in Manitoba with Jean Doucha and the Behavioural Health Foundation.   His recently published book, All the Way Home, tells of those early years. Today as well as being an endless crusader for truth and proponent of living life to its fullest, as a weekly talk show host  and addiction counsellor, he helped co found the first Recovery Day in Vancouver.
AnnMarie McCullough started the Faces and Voices of Recovery and began the first Recovery Day in Vancouver which now occurs nationwide.  She also leads work at Orchard Treatment Center.  She was radiant sitting beside me, her inherent beauty even more so, since her recent engagement announcement.
Lorinda Strang, Executive Director the the Orchard Treatment Centre sat next to me. Her experience and work in the field is especially well known to the community of West Vancouver where she raised her family.  Wealthy communities such as West Vancouver are preyed on by drug dealers, their children at greatest risk.  
Candace Plattor, Registered Clinical Counsellor, and author of Loving an Addict, Loving Yourself, completed our panel.
As moderator, David Berner opened by asking us all what we thought addiction was.
Candace spoke mostly to it’s impact on family and relationships as well as stealing the life from the individual.  In her work she as often cares for family members who find themselves pulled into the desperate chaos of those addicted to a variety of chemicals as well as the process addictions, like sex, internet, eating disorders, gambling.
Lorinda Strang spoke to the total destruction of the person’s life purpose and the loss of all their interests and relationships and their failures in their relationships and the workplace.  She described how positive it was that businesses and families were recognizing addiction earlier and getting these members to treatment centres such as Orchard earlier when successes were most assured. She described the denial process and the abhorrent thinking, the rationalizations that ‘explained away’ all manner of loss and failure but never addressed the addiction itself. She talked of the wasted lives she saw daily in their work, people arriving like zombies and becoming human again in their relationships with other, lives restored with hope and joy and purpose.  She spoke of detox as only a first phase but the next months made easier in a treatment centre but then the life long need for awareness. The disease of addiction is a waxing and waning  condition from which one may recover, as evidenced by the millions that have,  but still they carry the risk for relapse.
I spoke to the neurochemical evidence of disease, the  genetic evidence, the twin studies, fMRI data, the hijacked dissociative thinking likened to a computer virus or cancer so that a person begins to ‘worship’ and ‘serve ultimately as a slave’ their God of addiction despite ‘negative consequences’ such as health problems,  failure in school, athletics, loss of important relationships and inability to maintain or manage work at previous level.  Whereas I tended to quote studies and research and stats, boringly, impressed myself by the science, the others tended more to tell personal stories, speak of clients, their families, friends and lovers and the communities they knew.
AnnaMarie McCullough spoke to the negative effects on the individual and the community. She spoke to the stigma associated with the disease and the isolation the individual experiences and the road back to community which comes in the recovery.  She expressed concern about the ‘enabling’ individual and community services which were in as much denial as the individual with the disease of addiction. She spoke of Recovery Day’s function in increasing awareness and helping individuals and their communities see just how successful recovery is and how beneficial it was for the community.  She especially emphasized the joy that recovery restored and the love that people felt after often years of being desperately hiding and lying about their disease.
David Berner spoke to the grief and tragedy of the individuals who turned to addictions as their only solace and how this immediate relief then turned around and hurt them more and more as time went on.  He spoke to these individuals not wanting to be addicts, their mothers and fathers and brothers and sisters. He spoke to their being sick and the horrible lives they so often endured before  they became addicts. He spoke to the child who was physically and sexually abused and developed an addiction as a teen. More and more he said his concern was for the children who were turning to addictions and becoming horribly addicted because of the high risk teen agers have for addiction to marijuana, alcohol, cocaine, and all the process addiction. He said more and more the people he was seeing had not known any normal life having so often left homes and schools to follow their addictions.  He spoke eloquently for the tragedy of the addicted, their families, the loss to individuals and families. There is so much grief, he said.  He was sad that so many young addicts had lost the capacity to work and how much work had meant in his life, how addiction took away purpose from individuals he saw and yet how much joy he'd had himself having purpose in life and working to complete what he set out to do.
When the subject turned to treatment each individual spoke to the hope and the scientifically proven successes of a variety of treatments, the high success of 12 step programs and abstinence, the benefits of treatment centres and recovery houses, the amazing successes of the drug courts, the usefulness of urine testing and variety of medications and services that were of proven benefit.
Candace spoke of the benefits of the therapy to family members and how even when an addict didn’t respond family could learned to protect themselves from the consequences of the addictions and be prepared to help when they could.  She described her work of recovery with loved ones and how as they learned to take care of themselves the addicted one often came round.
Lorinda Strang talked  of the countless successes that she had seen in her 20 plus years working in Addictions and the work of the Orchard Treatment Center on Bowen Island. She described her anxieties raising her children in West Vancouver, the difficulties that wealthy communities faced when it came to addiction and what could be done for the community and the children.  Living in this community she had seen the success of recovery and still continued in contact with people who once were thought to be untreatable but had recovered and gone on to be shakers and makers of society.
I spoke of the need to treat addiction and mental illness, as a dual diagnosis.  Yes it was common for those who abused alcohol to be anxious and depressed (alcohol is a depressant - 2 drinks on occasion, beneficial, 3 or more drinks toxic)  No treatment of only the anxiety and depression was  going to improve the addiction. Freud said addicts and alcoholics were untreatable and Dr. Carl Jung said only a miracle would work.  Because addiction is a brain disease the thinking of the addict is diseased so one had to treat the addiction first then it was possible to address whatever mental illness was underlying. All the attempts at treating the ‘underlying’ conditions first were proven repeatedly to lead to failure in the majority of people, but especially children and teen agers.  It was like trying to stop the bleeding being made by slashing without taking the knife out of the persons hand.  Hence the dual diagnosis and concurrent treatment programs that focussed first on the addiction then as safety and stabilization was achieved more and more secondary treatment of the mental illness was incorporated into the overall treatment plan.
I said that the success of all addiction treatment was evident in the amazing society success of the anti smoking campaigns.  Being of an age when all such community meetings were in a 'cloud of tobacco' smoke one didn't even have to think of the actual incredible reduction in cigarette smoking in society.  The loss of adult sales had caused the evil tobacco empire to directly target children in their marketing campagns so to my mind, we'd stopped short not arresting the CEO”s of Tobacco Companies.
These were the people who were now looking to make even more money selling misery to the young  by offering their ‘marijuana smoke’ or maybe even a ‘lighter cigarette, one half tobacco and half marijuana’ . As Amsterdam and Holland have moved their BC Bud products into the most restricted drug category, the same as Heroin and Cocaine, these big business forces were pushing for legalization of marijuana so they could get greater access to the teen and children ‘customers’ .  All the abuse of drugs including heroin and cocaine, except marijuana, had been falling as a result of education and recovery but now big business was targeting the young with marijuana.
No smoke is ‘safe’ and all evidence points to the the extensive health costs of all smoke (tobacco, marijuana, cocaine) yet these same corporate individuals who profited from tobacco smoke are now funding the marketing behind the ‘legalization’ of another ‘smoke’.
(I think I got a little upset at this point and told of the three young men I’d seen last year who’d developed schizophrenia after smoking BC Bud, and spoke of my scotty dog being murdered by the drug dealers who objected to my refusal to lie about their positive urine tests when they wanted to get “safety sensitive’ jobs where the other workers there didn’t want cheech and chong ‘pot smokers’ in their midst because they caused so many workplace deaths and accidents’)
David Berner kept the topic on track and opened the floor to comments from the audience. One amazing young man spoke eloquently of his experience with addiction and recovery and seeing so many of his friend damaged by drugs and then those like himself who got clean and sober getting back to school like he did, getting work and having great lives compared to their previous lives.
The audience asked great questions.  Someone talked of Gabor Mate’s book, Hungry Ghosts and how it helped them understand the trauma of addiction. Asked about the use of hallucinogens to treat addiction, I pointed to the possibility of a ‘sexy’ treatment helping one individual in a thousand but that we’d seen such ‘sexy’ cancer cures come out of Mexico with false promise only to have people spend their life savings on these 1 in 1000 remedies and then die when they could have taken a safe and proven treatment.  
I commented on the local work and research of Dr. Ray Baker, who started the first Canadian addiction education program for medical students . Working in Occupational Medicine he speaks to the high success of addiction treatments, in the 80% range, when the disease is caught early enough that the person still has a job or is  in school and has supportive family.   Dr. Baker still shows that in those who are at the end stages of the disease, physical illness, unable to work, isolated, that the success that present day addiction treatments with modern approaches, 12 step programs, treatment centres and recovery centres is still greater than the rest of our medical colleagues treating end stage diseases like tuberculosis or diabetes.
There were excellent questions about the lack of government funding, specifically for adolesenct treatment facilities.  AnnMarie McCullough and Lorinda Strang spoke of the poor histories of past governments in their waking up to the epidemic of addiction but that increasingly the government has been on board with helping but still had to come to a better understanding. David Berner spoke of his meeting this week with the British Columbia Minister of Health, Terry Lake.  “Terry Lake was very concerned about addiction in the community, especially it’s affect on adolescents”.  The BC Liberals were invested in addressing the need for increased treatment.  An example was the support the new Turning Point Recovery House in West Vancouver had received from local and provincial government.
I answered the questions about changes in methadone ‘delivery’ policies stating that the primary concern of the College of Physicians and Surgeons of British Columbia was the safety of the citizens of BC.  The greatest concern of the College of Physician and Surgeons is the ‘diversion’ of methadone and the risk diverted methadone would pose for an adolescent or child.  The concern for that ‘risk’ was the basis of the review of the present day ‘delivery’ policies because some pharmacists had not been able to ensure the level of safety that the College of Physicians and Surgeons and their sister organization the College of Pharmacists require for the Methadone Program to run.
Regarding the question of Harm Reduction versus Abstinence I pointed out that the World Health Organization position was that all harm reduction program were only valid so far as they worked towards abstinence.  Controlled drinking had been a failure and as David Berner pointed out Mothers Against Drunk Drivers had done amazing work to ensure that judges, especially  remembered the danger that addicted persons posed to the community and didn’t just listen to the major alcohol  producer and sales lobby.
There was question too about some of the  more controversial local Harm Reduction programs. I quoted the Welsh study that showed that the lack of faith and hope of some counsellors for the recovery of their members was often far far less that the scientific evidence of success of the individuals themselves. In the Welsh study the ‘harm reduction’ counsellors had commonly given their ‘clients’ an under 10% or  30% likelihood of success when the follow up studies showed that 60% of these individuals a gained and maintained abstinence.  Dr. Marc Gallanter of Harvard showed that 80% of doctors maintained long term recovery in Alcolics Anonymous and Narcotics Anonymous many being 30, 40 and 50 years abstinent in his research.  I expressed the concern locally that no judge or doctor with addiction would be advised to accept a “harm reduction’ program whereas often that’s all my poor patients were being advised to take.  This white collar and blue collar approach to treatment was simply wrong.  Further when I talked to some of the harm reduction proponents they were really saying there was no 'hope' for their 'customers' and that they should be just given 'palliative care' (i.e. comfort, since no cure was available).  I found myself thinking of some of the people I'd met who had promoted 'euthanasia' for all mentally ill patients. I was so thankful that the Welsh study showed how wrong these individuals usually were.
Everyone loved Candace' concern for family and friends of addicts;  Lorinda’s experience and expertise helping individuals and family, the world renowned fine work of the Orchard Treatment Centre, AnnMarie McCullough’s passion for community and recovery and David Berners great sense of humour and skill as a public speaker and moderator.
I was just thankful to be apart of something very good  and be there for those special moments when David, AnnMarie, Lorinda and Candace’s words touched my very soul. The people who were present wanted the very best for their community as their presence, attention and questions showed.  I really admired them most

Orthotics and Dr. C

I was bitching and complaining about foot pain to my colleague and friend, Dr. George C.  He's a family physician with a gazillion years of experience, a really big brain and an even bigger heart.  I think he might have commented on my girth.  My recent excuse for my ponch has been the pain in my foot which "prevents me from exercise".  Of course I could bicycle but the 'knee injury' squashed that. Then there's swimming and all the stationary gym things one can do, yoga, tai chi and a whole range of alternatives but.....
"If you had my pain, you'd understand."
Dr. C isn't a small man himself and we both like fine cuisine.  He raised his eye brow.  He has a very expressive face but also likes to seed his medical knowledge into poems and stories he shares when he's examining you.
When he was examining my feet he asked if I'd tried orthotics.
"Orthotics?" I'd said, like it was some herbal snake oil combined with feathers you rub your chest cure for the flu - the internet is full of make the seller rich 'alternatives', aimed at the gullible unvaccinated.
So George told me about orthotics and  asked me more detail about how I'd 'hurt' my foot.
"Well," I said, "I was wearing 4 inch heels on Halloween walking downhill when I first remember ever hurting that joint. But since I don't usually wear high heels it went away until  a year later.  Now don't laugh, I kicked the ball for my dog, missed the ball and really stubbed my toe.  'Stubbed' doesn't do justice to the injury or pain.  A week after that when I was hobbling about a friend accidently dropped 5 lb weight on top of my toe. That was last year."
"What did you do?"
"I couldn't walk around hunting, so I just drove around in the truck.  I took aspirin, massaged it, and moved it about figuring keeping it flexible would help but it just got worse."
George was continued looking at me, his eyebrow had gone up  first at "4 inch heels" and never come down. I was waiting and ready for him to say something about the 4 inch heels  because it had been him who'd told me to go to the movie,  "Kinky Boots".  He and his girlfriend had nearly died laughing and later so had I. My nurse friend told me after my Halloween injury, "you don't even see women over 55 wearing 4" heels, what were you thinking'.  My female social worker friend indeed told me, "4 inch heels aren't made for walking in, dear".  George, a very wise family physician and friend, focussed on the feet.
"It's best to get a weight bearing foot xray to really know whats going on. That also helps them make an orthotic that would probably help."
So I went to the one xray place where they did the weight bearing foot xrays, I'd not even heard of such a thing. George said, "If you treated as many older people as I do you'd know all about feet.  It's one of things that gps see now with active and aging populations."
Next time I saw George he shared with me the "insulting personal attack on my youth and competence" that the radiologist (who obviously hadn't been breast fed)  had to say.  "arthritis".
How can a hip slick cool guy like me ,barely into his sixties. have something old people have?!
Before I could take a swing at George, threaten him with a lawsuit, or complain to the College about the incompetent diagnosis of the radiologist, George added, "Obviously,  "traumatic osteo" "arthritis"
I liked the sound of that a whole lot better, something a young Navy Seal might have.  I've told friends, especially women, since, liking the way it rolls of the tongue,"traumatic osteoarthritis'.  I also love the sympathy, almost sexual, I get sharing my vulnerability.  I love  how they touch my forearm arm and kind of coo.
I went to PARIS Orthotics in Kitsilano. These two orthotic specialists and  technicians examined my foot and walk and the xray. Together they talked  about me, like I was another old grey haired guy with a ponch, not the brilliant doctor with a lifetime of awards and accomplishments.  Quite disrespectfully and irreverently they  discussed my 'arthritic' toe, without the distinctive essential adjective  "traumatic osteo..."arthritis.
There was a very attractive woman looking in her  in her 40's at most, perhaps, waiting there too.  Seeing me walking before the watchful techs, she commented with a chuckle, "my teen age grandson calls calls mine,  'old feet'",
How humiliating! "My doctor says I have 'traumatic osteoarthritis", I corrected her curtly.
When the orthotics were made, very  bright and sensitive young Chinese orthotic specialist came with me to the shoe store to help me pick out a couple of pairs of shoes that would help best..
"I would never wear anything that stiff and clunky. I'd look like a geek idiot." I said when he showed me what would be 'best' but was definitely 'unfashionable' by my way of thinking.
"They're what I wear," he said, showing me.
Talk about putting your foot in your mouth.
To "undo" my faux pas, I bought them. I'm wearing them, today.  Just like he said, they're incredibly comfortable.  Now that I'm not hobbling, and generally feeling better, they actually don't look that 'unfashionable'.
I wore the orthotics, (space age medical insoles) and  still do.  I went from really sharp pain walking a block, which I'd had for months, to having little or no pain, most of the time.  I'm even thinking about dancing again and I pretty much given up on dancing again.  A truly depressive thought.
I got out hiking and hunting this year, pleasing my little dog to no end.  He's really not a 'truck hunter',  just loves to leap and bound about with the sheer joy of happy cockapoo feet. I'm not there yet. But I'm a whole lot better than I was.
I accepted expert advice and followed the directions of a leading  family physician and got Orthotics.  That took away my excuse for the pear shape.  I haven't come up with another good excuse but I'm considering  sueing  Hagen Daz and Ben and Jerry's Ice Cream. Everyone I share that with tells me it would be a great 'class action' suit.
 Meanwhile I'm actually hiking, swimming and enjoying life. I have not told Dr. C this. I wouldn't want him to become smug.  He's helped and cured so many people it's probably good he goes to church too. Without the humility of a Christian life, he might actually get to thinking he was Jesus.
As a psychiatrist, I'll thank him of course, but add,
"I still can't walk on water, and you call yourself a doctor!"

Gratitude Jan. 16 2014

Thank you Lord for this day. Thank you for Gilbert my cockapoo friend. Thank you for my bed and my home. Thank you for the heat in the winter. Thank you for the running water and the electric lights. Thank you for the couch and chairs and table and floors and doors and roof.

Thank you for my breath, Lord. Thank you for my beating heart, my eyes that see, my hearing and sense of smell, my feeling and my beingness. Thank you for my mind and brain and soul. Thank you for my understanding and for wisdom. Thank you for my communication in all its forms. Help me ever to do thy will. Help me to be in the flow of your purpose.

May my light within shine with your light, Lord. May the god part of me that is you be what is manifest today. May I more and more know you and know the god part of you in others. Might I love others as I love myself.  May I know that my self is yourself , that the power within me is from the higher power that is you.  May I be one with you. Holy Spirit, Come.  Fill me with light and love.  

God help me to day in all my endeavours.  May I do thy will. May I help all others with your guidance and wisdom. May my work and day be suffused in you Lord.  

Be with those now who are grieving. Be with those who are in tragedy. Lift up those who sorrow.  Be to those I love all that you all to me, protector, provider, guide, and father.  

Thank you Lord for this life and this day.  May I be a channel for your love and your peace.  Thank you.

Killing Season - the movie

Just watched Robert de Nero and John Travolta in an amazing male meeting of post Bosnian Serbian war veterans.  They talk of the fog of war during conflict but there’s sure a lot of confusion after. This is one of the most amazing PTSD, Survivor Guilt and all those other catch phrase psycho babbles we throw about like we know something about the depth and mystery of the human mind and heart. I loved this movie.  So simple and beautiful but heart rendingly intense.
Two combatants meeting 18 years later, lives changed forever by their first meeting in the midst of combat.  The psychology and theology of the words spoken between warriors would require tombs of writing. The photography, in the war overseas and the Appalachian mountains was amazing. It complemented the rustic rawness of  the movie touched.
And “we" send young men to war.  As “they" do too.  To protect the women and children who say they don’t want us to but women seem less able to agree on anything than men.  All it takes is one Eva Brawn or one Hitler then all bets are off.
These two men are not white knights, American and Serbian. They are human and this is one of the most poignant human dramas I’ve seen acted by two of the greatest actors of my age.  Thank you, to all who made this film especially  Director Mark Steven Johnson.
Know your enemy.

It's an new year and I pray to know love - song

C            G                F                   C
It’s a new year and I ask for less fear

It’s a new year and I long for less tears
C                      G                           F
I pray to know love and feel more joy (x2)

Am                  G                       Am
Dancing in the wilderness with friends /Sailing on the oceans without end
Living in the moment alive/Savouring all the good times /Till we die

You and me were meant to be free/Laughing and celebrating life
Never forgetting something more/Than the conflict and strife

(I used my iPhone to record, played my Washburn Rover, and sounded flat in some places. I've not been singing or playing guitar much. Still shamelessly creative.)