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.
Friday, August 27, 2010
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...
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...
Thursday, February 11, 2010
Addiction Medicine a medical specialty
Well it has finally happened... in December 2009, the health minister has recognised Addiction Medicine as a medical specialty. What will this mean to those of us practising in the field? Time alone will tell, but I certainly hope that it will help to attract and retain doctors in work within drug & alcohol treatment services.
The next step in the process will be discussions on Medicare rebates. The challenge will be for the disparate collection of doctors that make up Addiction Medicine to come to some sort of agreement about what the models of billing "should" be...
Watch this space...
The next step in the process will be discussions on Medicare rebates. The challenge will be for the disparate collection of doctors that make up Addiction Medicine to come to some sort of agreement about what the models of billing "should" be...
Watch this space...
Tuesday, September 22, 2009
Legalising Heroin?
<http://www.theage.com.au/national/legalise-addicts-heroin-experts-20090922-fyse.html>
I had a sense of deja vu reading this article in The Age this week. There have been murmurings about legalisation of heroin in Australia for years now.
The arguments for legalisation are sound. Take away the illegality and the black maket prices should be less astronomical, and the people who do use the drug are less exposed to legal harm and more likely to seek help when they need it.
However, there also has to be a balance with retaining enough control so that the legal supply doesn't end up being diverted in large amounts into the black market.
The experience overseas has looked at models where people on heroin treatment had to use the drug onsite at a drug treatment clinic. This has the advantage of being supervised therefore reducing the risk of diversion into the black market. It does require adequate resourcing to provide appropriate staff and facilities, especially considering the fact that heroin is relatively short acting and the frequency of injecting is sometimes several times per day.
Certainly worth at least considering as an option...
I had a sense of deja vu reading this article in The Age this week. There have been murmurings about legalisation of heroin in Australia for years now.
The arguments for legalisation are sound. Take away the illegality and the black maket prices should be less astronomical, and the people who do use the drug are less exposed to legal harm and more likely to seek help when they need it.
However, there also has to be a balance with retaining enough control so that the legal supply doesn't end up being diverted in large amounts into the black market.
The experience overseas has looked at models where people on heroin treatment had to use the drug onsite at a drug treatment clinic. This has the advantage of being supervised therefore reducing the risk of diversion into the black market. It does require adequate resourcing to provide appropriate staff and facilities, especially considering the fact that heroin is relatively short acting and the frequency of injecting is sometimes several times per day.
Certainly worth at least considering as an option...
Thursday, September 3, 2009
Alprazolam misuse
http://www.themercury.com.au/article/2009/09/04/95181_most-popular-stories.html
Yet another report on prescription drug misuse...
Alprazolam is one of my particular bug bears. What is it about alprazolam that makes it such a problem in misuse? In brief terms, it is very potent, quick to act, and short acting... an absolutely disastrous combination.
The effects of alprazolam, apart from reducing anxiety, are sedation, reduced inhibitions, impaired judgement and loss of memory. When it is misused, you find people who have their inhibitions removed (a bit like alcohol actually, but the effect comes on quicker) and will therefore do really stupid, impulsive, reckless and sometimes violent and antisocial things. They are sedated, and therefore have poorer control over functions like walking and running, and are therefore more likely to get injured. The memory loss then kicks in and they can't remember the stupid things that they have done or how they got injured...
Does alprazolam have a legitimate place in the treatment of anxiety? Yes, but a small one. It may be useful in responsible and reliable individuals in the acute treatment of a panic attack as a "rescue" medication. There is absolutely no rationale for its use as an ongoing, regular-dose medication. If a benzodiazepine is being used as a regualr dose (and the usefulness of that for anxiety is debateable) then a slower acting and longer acting agent is much more likely to provide a stable effect.
Being a potent sedative, the additive effect with other sedatives is also more of a risk with alprazolam. This represents a bigger overdose risk.
So how do we ensure that the patients who need alprazolam have access and still reduce the risks involved in misuse? I believe that, similar to Rohypnol, alprazolam should only be available on authority (no private prescriptions) with the recommendation of a psychiatrist after the patient has had a comprehensive psychiatric review, and that one of the contraindications that would prohibit prescribing is a history of misuse of any substance (alcohol and other drugs).
Yet another report on prescription drug misuse...
Alprazolam is one of my particular bug bears. What is it about alprazolam that makes it such a problem in misuse? In brief terms, it is very potent, quick to act, and short acting... an absolutely disastrous combination.
The effects of alprazolam, apart from reducing anxiety, are sedation, reduced inhibitions, impaired judgement and loss of memory. When it is misused, you find people who have their inhibitions removed (a bit like alcohol actually, but the effect comes on quicker) and will therefore do really stupid, impulsive, reckless and sometimes violent and antisocial things. They are sedated, and therefore have poorer control over functions like walking and running, and are therefore more likely to get injured. The memory loss then kicks in and they can't remember the stupid things that they have done or how they got injured...
Does alprazolam have a legitimate place in the treatment of anxiety? Yes, but a small one. It may be useful in responsible and reliable individuals in the acute treatment of a panic attack as a "rescue" medication. There is absolutely no rationale for its use as an ongoing, regular-dose medication. If a benzodiazepine is being used as a regualr dose (and the usefulness of that for anxiety is debateable) then a slower acting and longer acting agent is much more likely to provide a stable effect.
Being a potent sedative, the additive effect with other sedatives is also more of a risk with alprazolam. This represents a bigger overdose risk.
So how do we ensure that the patients who need alprazolam have access and still reduce the risks involved in misuse? I believe that, similar to Rohypnol, alprazolam should only be available on authority (no private prescriptions) with the recommendation of a psychiatrist after the patient has had a comprehensive psychiatric review, and that one of the contraindications that would prohibit prescribing is a history of misuse of any substance (alcohol and other drugs).
This is good
I really like this short clip produced by a couple of guys in Amsterdam in response to some harsh and judgemental commentary coming out of America...
http://www.youtube.com/watch?v=sTPsFIsxM3w&feature=player_embedded
http://www.youtube.com/watch?v=sTPsFIsxM3w&feature=player_embedded
Friday, August 14, 2009
Workforce... what workforce?
How do you overcome the challenges of staff turnover?
Over the last month or so, the clinic I work with has lost 2 case workers and 1 outreach worker, and is about to lose a doctor and a social worker within the next 2 weeks. We have advertised, and there has been some promising interest, but even when we recruit we are still faced with that lag time as the new staff members learn their jobs. All this whilst trying to maintain care to a population that is often difficult to engage with.
Drug and alcohol work is not glamorous and is often frustrating, and yet when you get a win (as rare as they are) and you see someone that you are working with get better you really value it.
When you look at the work environment, the people who work in the AOD sector are often faced with aggressive behaviour, emotional distress and people in crisis situations. Is it surprising that people don't stick around?
Over the last month or so, the clinic I work with has lost 2 case workers and 1 outreach worker, and is about to lose a doctor and a social worker within the next 2 weeks. We have advertised, and there has been some promising interest, but even when we recruit we are still faced with that lag time as the new staff members learn their jobs. All this whilst trying to maintain care to a population that is often difficult to engage with.
Drug and alcohol work is not glamorous and is often frustrating, and yet when you get a win (as rare as they are) and you see someone that you are working with get better you really value it.
When you look at the work environment, the people who work in the AOD sector are often faced with aggressive behaviour, emotional distress and people in crisis situations. Is it surprising that people don't stick around?
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