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Thursday, February 28, 2013

Lethal Capacity and Potential to Kill -- "Thanks, Doc. I Was Afraid It Would Hurt."

"Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

"Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."

("Short Definition of Addiction," Public Policy Statement: Definition of Addiction,
American Society of Addiction Medicine, 2013)

Addiction: The "A to E" Characteristics

A.  Inability to consistently Abstain

B.  Impairment in Behavioral control

C.  Craving; or increased “hunger” for drugs or rewarding experiences

D.  Diminished recognition of significant problems with one’s behaviors and interpersonal relationships

E.  A dysfunctional Emotional response.

Although these five features are not intended to be used as “diagnostic criteria” for determining if addiction is present or not, the characteristic features are widely present in most cases of addiction, regardless of the pharmacology of the substance use or the reward that is pathologically pursued. Each feature may not be equally prominent in every case.

"The diagnosis of addiction requires a comprehensive
biological, psychological, social and spiritual assessment
by a trained and certified professional."

(American Society of Addiction Medicine, 2013)

Addiction is not a term or a diagnosis to be applied casually or dispassionately; for those truly afflicted, it is of life-consuming and mortal consequence. It is a significantly different and distinct "beast" from complex and persistent dependence.

In The War of the Gods in Addiction (2009), psychoanalyst David E. Schoen, LCSW, MSSW, describes rather dramatically what he believes are two essential components of addiction…
“First, the addictive substance… must ultimately take over complete and total control of the individual, psychologically. That is, it must take over control of normal ego functioning — thoughts, emotions, perceptions, motivations, judgments, decisions, actions, and behaviors.”           
“And the second part of this definition is crucial: the addiction takes over control in an inherently destructive and ultimately life threatening way. It is not an addiction unless it is a death sentence… of the mind, of the emotions, of the body, and of the spirit.  
"It is a death sentence to the addict’s career, community, marriage, family and friends. It is not an addiction unless it has the lethal capacity and potential, the power to kill the individual. It is not an addiction unless it is the most powerful, controlling, possessing, dictating, and determining agenda in the psyche. It must take precedence over everything else.”

My Take

Without sufficient research-based, clinical training and firsthand witness to those who can relate their personal experiences of dependence and addiction, prescribers of prescription drugs (medical doctors, dentists, etc.) cannot have the expertise needed to determine how to treat those in chronic pain.

At this time, most doctors do not have adequate training in managing those in moderate to severe pain. What little education they have received has come from pharmaceutical companies who sell pain relievers that they claim can be used to treat pain symptoms, not cure the ailments that cause the pain.

Many of these substances can lead to dependency and addiction. Voluntary compliance to complete painkiller training is in effect; however, the risk factors associated with taking many of these medications demand that doctors have mandatory training.
Look at the two definitions of addiction again. In many ways they are alike, yet the American Society of Prescription Medicine definition is much more cold and clinical than Schoen's emotional, "death sentence" definition associated with potentially destroying the human psyche and all personal social relationships.

Can you see my point? Anyone treating those racked in physical and psychological pain cannot ignore the debilitating effects of the "hurt." But, first of all, these doctors must be sufficiently educated in proper pain treatment and pain management. The public must not assume a doctor's medical degree includes sufficient completion of that specific training. In fact, in most cases, having proper prescription education depends upon the voluntary initiative and concern of the individual medical professional.

Equipped with the knowledge of how best to identify and treat pain in all its many forms, a doctor must then find the source(s) of the patient's pain and develop safe treatment based on an accurate diagnosis in order to continue with the best prognosis. These procedures are very difficult tasks that usually require repeated treatment, adjustment, and close management of pain medications.

Thus, enters the potential for dependence and addiction -- the professional decides to continue treatment of the patient's moderate to severe pain with the FDA-approved opioid painkiller. The very substance that stops the pain has the power to overcome the patient and make him/her dependent, then addicted'

An over-medicated patient is, at first, happy and unaware of any impending danger. Yet, as he soon perceives his sense of well-being is tied directed to the prescribed substance and increased resistance enters his being, he craves more significant doses to keep him "level." But, eventually he becomes impaired and exhibits most of the "A to E" characteristics, and they continue to progress with his overwhelming chemical consumption. He becomes totally dependent on his altered state of being. 

His dependence spirals into addiction, and he is rendered dysfunctional. He has become a distorted, ugly veneer of his true being. Pills possess his insides as he lives the will of his pain. As reason deserts his mind and chemical needs overtake everything else in his world, his only perception of salvation is his next fix.

You needn't tell him about the possible ways out. His only friends then are addicts, and all of them know the truth. The problem is that so many of them are so wounded that they cannot prevail to fight the odds. They know the odds are that they are headed for prison or for the grave. The exceptional addicts pull themselves up through rehabilitation with the grace of a strong will, the dedication to long and tough medical intervention, the forgiving help of loved ones, and the grace of Almighty God.

If and when death occurs, the addicts immediate family and friends are left scarred and perplexed and in deep pain themselves. An addict's death leaves holes in the world -- gaps and crevices he had no idea his demise would help create. Some of them are obvious like torn families and shattered dreams. Others are hushed and carefully concealed like debts and dark, detrimental associations.
And perhaps the biggest, most distressing fissure of all 
grows at the end of a pen
wielded by a health professional who continues
 to be an unknowing or uncaring accessory
to murderous Rx addiction
as he prescribes continuous opioid pain medication.    

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