The Second Road Family » The Doctor Will See You Now

The Doctor Will See You Now

Hi all,

Thanks for having me on the site. I’m just back from the American Society of Addiction Medicine annual meeting where I attended some scientific sessions and was asked to give a reading from my new book THE ADDICT: One Patient, One Doctor, One Year, to a large group of addiction and pain specialists, as well as psychiatrists, nurses, and counselors. Of great interest to me was the growing number of reports I heard of doctors, or doctor groups, refusing to write prescriptions for narcotics to anyone in their practices. Simply declaring this as a policy. It seems that many out there have been “burnt” by patients ( or are burnt out for other reasons) and find the easiest way to “protect themselves” is simply not to deal with pain issues pharmacologically. I wonder what happens to these patients in their communities, and really how vigilant these physicians are in this odd practice?

I also listened to an interesting talk on the cumulative data indicating the power of 12-step programs, well-known to those who attend, but not well-researched or known to the treating community.

Finally, I’d like to remind all readers that the Wellstone mental health and addiction treatment parity bill is open for comment thru the Federal Register for the month of May and it’s important that all of us weigh-in and trying to shape this into real-world help for those who need treatment. I’m not sure what any readers want to discuss, but I’m delighted to be of any help that I can.

Michael Stein, M.D.
Professor of Medicine & Community Health
Brown University
www.michaelsteinbooks.com <http://www.michaelsteinbooks.com/>

Tags: 12 Steps, pain, painkillers, Paul Wellstone and Pete Domenici Mental Health Parity a, the addict

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May 8th, 2009 at 9:14 am
A. Miles

Hey Dr.Stein, Welcome! I’ve heard great things about your book.
I’m really concerned about the federal crackdown on Doctors. From what I’ve read, diversion (of pharm shipments) is the bigger reason there are so many pills on the market, and that responsibility rests on the DEA. Doctors should not be punished nor monitored for treating people who really need painkillers. I think more training would teach Doctors to know who is “shopping for pills.” It’s a messy situation and I would love to know what I can do as a citizen.

Thanks for being here!
May 8th, 2009 at 4:03 pm
Michael Stein

Thanks for writing. One thing that good medical centers are looking for are teachers from the community who can offer medical and nursing trainees a new vantage. If you live near a university medical center, and you’d like to teach young docs about addiction ( including how to recognize patients who are only looking for pills), contact the general medicine, addiction or emergency medicine divisions (by email is best), and offer to help with a teaching session on the subject. Try to find someone who runs a training program for one of those divisions. They might not even have thought of this topic, but hopefully someone enlightened will be receptive. I know this is a lot of work for you, but it could potentially help.
May 9th, 2009 at 11:18 am
Margaux

Welcome, Dr. Stein. I actually just finished reading “The Addict” and loved it! I look forward to reading more of your thoughts here.
June 5th, 2009 at 11:47 am
The Second Road Family » Dr. Michael Stein hosts Sunday chat

[...] addict, as she seeks to overcome her addiction. Dr. Stein will be blogging at TSR on occasion; his introductory post is here; feel free to leave your questions for the Doctor. His book has been reviewed by Ginger and can be [...]
June 5th, 2009 at 11:59 am
RUKiddingme?

Hi Doc, Your book looks like an interesting read. I’ll have to get a copy. Even though I’ve been sober some time, I know I’m not too recovered to learn something new. In fact, I’m really just beginning. Take care.
June 5th, 2009 at 2:42 pm
Michael Stein

Thanks for picking up a copy. let me know what you think
June 5th, 2009 at 5:56 pm
prefer not to say

Hi Dr. Stein,

I finished reading your book about a month ago and very much admired your fidelity to the patient’s experience and point of view. I also admired your willingness to think about the things that doctors just can’t know.

In reading your book, Iyour mention of 12 step programs struck me as mostly cursory, and at times dismissive. I liked that you called attention to the uncomfortable gender dynamics that make 12-step meetings a less-than-perfect venue for a recovering addict. On the other hand, I tend to be pretty impressed by committed 12-steppers. I was wondering if you share some of your own thoughts and impressions of 12 step programs. Do you see it as one of many options? Do you see it as not suitable for some types of addicts?

I’m not a 12-step ideologue, so I promise I’m not asking in order to start a debate. I’m just curious what 12-step communities look like from your perspective.
June 7th, 2009 at 8:34 am
The Second Road Family » Dr. Michael Stein hosts Sunday chat

[...] prefer not to say: Hi Dr. Stein, I finished reading your book about a month ago and very much admired your fidelity to the patient’s experience and point of view. I … [...]
June 7th, 2009 at 4:08 pm
Michael Stein

The material on 12-step groups in “The Addict” was based on 1) what the specific patients whom I was writing about thought, and 2) what’s known from the published research literature. I did not present my views thoroughly there, and lots of folks have commented on that. Here’s what I think: 12-step groups are fabulously helpful for a lot of people. Only a person with his eyes and ears closed would deny it. A deep commitment to one or another group ( and finding one that fits often takes an individual some time) has changed the lives of many of my patients. I recommend checking out groups to every single patient I treat, and repeatedly, and I direct them to groups I’ve heard are supportive. Unfortunately, a large minority of my patients either refuse to go to a single meeting, or have had bad experiences with one or more groups. No matter how forcefully I suggest, they don’t want to hear the good stories I have to tell about joining a group(s). That’s what I tried to represent in my book. But I’m certainly a believed in the power of personal support in its many forms.
June 27th, 2009 at 10:22 pm
Thea123

I am half way through your book and find it very interesting. You write beautifully and are refreshingly candid. I do however find
therapeutic openings which could have been pursued differently by a specially trained therapist(see 2nd para page 122 for example) with more than just a question/answer sort of format. You rightly mention on page 123 that talk therapy plus meds leads to better outcomes and say “a psychiatrist isn’t required, an internst will do.” Seriously, wouldn’t this patient have been better served by seeing you AND a licensed therapist, preferably a female as a counterbalance? You treat the whole spectrum of internal medicine patients and provide solo addiction psychotherapy?
You book is far more nuanaced and provocative than Drew Pinsky’s which seemed an oversimplification, but I have some of the same concerns with him. In the admittedly few episodes I watched of his ethically questionable show, Celebrity Rehab, I never saw a licensed therapist assisting him with group or individual treatment. (Maybe they were concerned with consent/ethical issues around the filming).
Don’t you think your patients, and even yourself in consult, would benefit from added therapuetic assistance from a mental health professional?