What I don't love is working with addicts. Well, lemme rephrase that. I don't like working with addicts that haven't worked on their addiction in any way, shape or form. Addicts that have surrendered I like. Those that have gone to AA/NA I like. Those are the type of people I can work with. Cause they see they have a problem.
What I mean by that, is that some addicts don't see a problem with their substance use despite all evidence to the contrary. Despite having six owi's, having lost multiple jobs/marriages or having had multiple detox stays at yon hospital. Those are SIGNS OF ADDICTION. THEY INDICATE A PATIENT HAS A PROBLEM WITH alcohol or other drugs. I'M NOT MAKING IT UP.
IT'S NOT MY DEFINITION OF ADDICTION PEOPLE. That is the definition of addiction. Continued use of substances despite repeated adverse consequences.
So, addicts come to me cause I carry a prescription pad. I can prescribe controlled substances. I don't though. Well, not very often. This is disappointing to the active addict in my office. And I do my best, be my most polite, use my most motivational interviewing technique to CALL ATTENTION TO THE BIG ELEPHANT IN THE ROOM. That they are seeking drugs to feed their addiction.
And I won't participate in such tomfoolery!
The problem is, is that addicts can be very forceful. Or try to be forceful anyway. They get loud, stand up and curse. They'll claim malpractice on my part or get weepy. They'll act out by harming themselves. They threaten and/or call me the b word. All of which is the addict's brain talking. I don't take it personally.
But the thing is, now a days, from the time I wake up until the time I fitfully fall asleep I feel like I'm gonna throw up. I'm tired and wrung out. I have but no patience for my addict patients.
SO after the forth addict came to me this week, being forceful as all get out, I kind of lost it. My powers of gentle persuasion, logical explanations, offer of multiple different medications, all of that fell on deaf ears. And my patient kept arguing with me. For 25 minutes.
THEN I PUT UP MY HANDS. He shut up.
In a clear and very loud tone, with my face all flush, I said, "THIS is my final offer. WE do x or y. Or there are 4 other prescribers in this office and many more in this city. You are hear voluntarily, you don't need to be here. Either choose a plan or see someone else. BUT I am not discussing the xanax again."
Cause really, those in active addictions cannot be reasoned with. So my futile attempts at logical and patient centered interventions fell on deaf ears. Maybe I crossed over the line. I should have kept my cool. But, I'm only human. But, I need to be more direct I think. 25 minutes is way too long to argue. So, maybe next time I'll blend the direct approach though.
And that's the thing, there will always be a next time. Cause 80% of all addicts have some sort of mental illness. :)
ok, good. feels good to get that off my chest. Now, if you'll excuse me, I'm gonna throw up.