Friday, August 27, 2010

My thoughts on Ben Cousins and his retirement from football

I admit it, I was one of the many glued to the television watching the Ben Cousins documentary.

As I listened to his narrative, I couldn't help but reflect on the interactions I have on a day to day basis with people who struggle with addiction but are not in fame's spotlight. His words rang true in many ways, but I feel that there are still aspects of his condition that he has yet to face.

Ben Cousins certainly speaks like someone who has been in therapy and dealing with treatment services for a long time. The repetition of the statement "addiction is a chronic, relapsing condition" is certainly a concept that treatment services work hard to impart to people - it is a health condition that can be managed with ongoing treatment, but we don't have a cure for. He clearly has an intellectual appreciation for what addiction is; time will tell how well he translates the information he has been given into real life changes.

Growing up in Western Australia, and being a West Coast Eagles supporter for many years, I remember clearly the draft when Ben was picked up under the Father/Son provisions inot the Eagles squad. From the beginning he was a high profile draft pick, with the media waxing lyrical about his football talent and the sheer good fortune of the Eagles recruiter that his father Brian played for the WAFL. What is the real impact of throwing that much adulation (not to mention the money) toa 17 year old?

In part 2 of the documentary, the story of recovery is closely linked to the story of returning to footy. Being an AFL player is what has given Ben Cousin's meaning in his life. The striving and the adrenalin of the competition is something that obviously lifts him and gives hims a rush.The structure and discipline of training clearly helps to impose structure on his life in general. What does a person do when the thing that gives life meaning is no longer there? There is bound to be a period of grieving and a sense of loss - how will he respond to this?

One of the concepts I discuss with the patients I see who see me for addiction related issues is readiness to stop using. When the drug is taken out of someone's life (removing all the rituals that go with obtaining and using the drug, all the social contacts that are held together by drug use, the pleasant sensations of euphoria or relaxation or absence of pain related to drug use) it leaves a whole, a gap. Filling that gap with positive things is a key element in the prevention of relapse into drug use. To my eyes, Ben filled the gap by working harder on his footy - take away the footy and what else will take its place? What will he do with the time that he used to train in? If he doesn't have the rush of getting out on the paddock on game day, what else in his life will give the rush and buzz? When the AFL isn't looking over his shoulders monitoring him for drug use, will he let his guard drop?

This is a critical time in his recovery. I wish him well in his recovery and with building good things in his life.

Monday, August 16, 2010

...the system (by which I mean Medicare)...

Since I last comented on this blog, Medicare in its wisdom has indeed allocated item numbers to the specialty of Addiction Medicine.

For any chance reader unfamiliar with the Australian system, a Medicare item number is a description linked payment that the goverment insurer (Medicare) will pay for a type of interaction a health provider has with a patient.

With a significant lack of consultation, or maybe a consultation with the wrong parties (still trying to work that out), the government decided to allocate 2 items for the specialty - an item for new patients and an item for reviews. There are no collaborative care or team care items, no items linked to referrals to allied health professionals, no group therapy items, no care plan items... Basically the items in no way match the style of practice which most Addiction Medicine SPecialists actually practice. I don't know any one of my colleagues who doesn't work with psychologists, social workers, AOD nurses and counsellors as part of their standard practice.

Needless to say, we are attempting to negotiate further on this matter. First of all, we need to get this pesky little thing called a Federal Election out of the way so we know which team we will be negotiating with...

I'll keep you posted...