My Lousy Bedside Manner

I receive about a dozen e-mails each day asking for advice; some are quite long, and while I would love to be more helpful there are days when I don’t have time to even read them, let alone answer– so please understand if I have not gotten back to you. One thing that has also ‘soured’ me a bit on personal communication is that I forget just how messed up addicts ARE– how distorted their world becomes, and how frustrating it is to become involved in trying to help someone who is not yet ready to be helped. I am going to post an exchange I had yesterday and today with one such person… I was way up north this weekend and not connected to the internet, but I received an e-mail on my i-phone and at the time had nothing to keep me from reading it. Having read it, I felt sympathy for the person and gave my honest opinion on the person’s dilemma.

I don’t have time (of course!) to make comments all the way through, and so I will only post the exchange; my goal is not to humiliate the person, as nobody knows the person’s identity. But for those of you who are enjoying some sobriety, the exchange will be useful; you will recognize the self-centeredness and self-pity that prevent sobriety from taking hold. In a treatment center, this person would be given a choice: shut up and listen, or leave and return when you are ready to shut up and listen. She wants support, I suppose– but support will kill her. That is one of the most fatal, and most common, mistakes made by using addicts; that they need ‘support’. That thought allows them to reject all of the calls for change that people take the time to provide. She will keep going from person to person, looking for someone to be ‘supportive’. But the only thing that will sound ‘supportive’ will be advice that keeps her right where she is! ‘Support’ for a using addict is only another form of enabling.

Now, once a person is at a different point of treatment– at a point where she is following instructions, and has gotten past the self-centered ‘terminally unique’ position– a certain amount of support may be useful. But this person is not even in the ballpark for that approach. If she is reading (and I doubt she is, as addicts tend to avoid reading things that stir up awareness of a need for change), I recommend she drop the one-woman pity-party and realize that her life is up to HER, and her alone. If she doesn’t get serious, she will end up just another dead junkie– and for that I am sorry. But I can promise you that me being a bit ‘kinder’ would not have been the answer to keep her alive.

Her Note:

Hi Dr. I am writing to you for help. I am a forty year old female who has been addicted to opiates for twenty years. Eighteen months ago I got clean (mainly from Norco and Fentanyl). I felt wonderful for months and then the pain started again (or my head said it did?) I have a disc protrusion. I went to my psychiatrist (also an addictionologist) who presbcribed suboxone. Now almost a year later I am on 8mg 3x per day for a total of 24mg. I hate this medicine. I am numb just like when I was on vicodin! I cannot go to the bathroom I have severe constipation and have to do a relistor injection every 48hours and take six stool softners and four laxatives to go to the bathroom once a week! I am having rage feelings again just like when took too much vicodin and I am flying off the handle at people, I am angry and numb and I hate everything. I don’t tell my AA friends that I am on subs because I am ashamed of it and I feel like I am still in active addiction. I have tried to get off it and every time I end up back up to 24mg. It does all the things it’s not supposed to do, I crave it just like vicodin. When I was down to 12mg I was unable to stay at that dose, I had to take more, just like vicodin! I know you”ll say that’s not possible but there it is anyway. Some days I take 32mgs and it’s hard to stop myself????? I want to stop this stuff so bad and I can’t and I’m petrified of the side effects and going through withdrawl again. Somehow I convinced myself that I could wean myself off subs with vicodin!! I didn’t taper off the subs (I couldn’t) and yesterday I had had my morning dose (8mg) and then five hours later I got a script from my dentist for Vicodin and stopped the subs and started taking the vicodin and of course now I can’t stop so yesterday I took 4 and a half tablets (7.5mg tablets) and today I’ve taken three already and it’s only 2:00pm. What’s going t happen when I run out of vicodin? Am I going to go into withdrawl anyway? I am so scared right now and I am too ashamed to call anyone, my therapist, my psychiatrist, my sponsor… anyone! Please help me if you can.

My Note:

Hi– thanks for writing. You are not alone in your situation; the bottom line is that Suboxone is only a tool, and if it is not used correctly, people will not do well with it. The person treating you should have ‘reigned in’ that extra use right away by refusing to give early refills; after a couple times of running out early and having withdrawal, you would have learned to keep the dose under control. At this point, I just don’t know if Suboxone is the right med any more for you– you need some way to get your motivation back, so that you will be able to limit yourself. That usually takes a bad experience that gets you to some sort of ‘rock bottom’. Addicts repress the feelings of shame you refer to– the goal of treatment is to keep those feelings from being pushed aside, so that you will remember them when you need to do the right thing for your health. A few suggestions: -read my blog, suboxonetalkzone.com, the post on optimizing absorption of Suboxone– make sure you are getting it in your system in a high-enough concentration. Search on the blog for ‘optimizing absorption’ and you should find it. -the effects of Suboxone peak at about 4 mg per day; everything else is psychological. You want to dose ONCE per day– take 16 mg in the MORNING ONLY– one tab, and then the other. If you get cravings later, you need to distract yourself for 10 minutes, and they will be gone. YOU CANNOT JUST KEEP DOING WHAT YOU WANT TO DO. You have the power to make it work, but perhaps you have a personality where you usually get away with bending the rules. IF YOU WANT TO GET BETTER, YOU CANNOT BEND THE RULES. These things I am suggesting MUST be followed if you want them to work– you cannot do just what YOU want to do, as that is what is destroying you. -Do NOT take extra doses to work or out in your car, etc– give the tabs to someone who cares about you and who is able to say no to you, and have them give them to you each morning– two pills each morning ONLY– no exceptions. If you don’t do that because you don’t want the inconvenience, then there is nothing anyone can do for you– you have to be aware enough of the danger to do what it takes to stay clean. If you dose only in the AM, and distract yourself if you get cravings, eventually the cravings will go away. But you CANNOT take shortcuts, or think you are somehow ‘unique’ and don’t need to follow the rules!

Her Note:

Wow, your bedside manner sucks! I get your point but insulting this addict makes it impossible for me to respect you. I read your arguments with another addict that said you were angry and personalized everything and now I believe it! I’m sorry I asked for your help. Clearly you have your own issues to contend with. I wish you well. Please dont bother responding, I’ll delete anything further you have to say. Peace!

My Final Comment:

People who are getting an understanding of what addiction does to personality will recognize this dynamic. It used to bother me– now I realize it is just addiction. But it does remind me that you really cannot help an addict until the addict is ready to be helped– and if you try, you will often regret ever wasting your time.

JJ

4 thoughts on “My Lousy Bedside Manner

  1. Well I hope you changed your mind Miss and read these comments from other addicts. This Dr. just tried to save your life and did a great job of it. I wish you would re-read what he wrote after you calm dow or rather on another day. I did not see one attack or insult directed toward you at all. Such a high dose it just so not necessary. IThat craving shit getting down to 12mg is all in your head. Stay on this forum and others and keep asking for suggestions BUT YOU MUST BE OPEN TO THE SUGGESTIONS. I hope you decide to listen.
    In your defense there may have been a time that I read an exchange with the Dr. and someone and seemed as though he personalized and was angry at THAT PARTICULAR TIME AND PERSON but who doesn’t at one time or another. Please re-read what he said and I hope your still around.

  2. I’ll never claim to be perfect– that would just be silly! I am usually rushed, and most days I am dealing with frustrations– today I had a guy who I thought was doing great relapse, and that is a real bummer for him– but me too. And heck, I realize that THESE days, everyone is on edge– my job is no tougher than anyone else’s. But understand that I am an ADDICT– I have the same sensitivities as everyone else. So I WILL occasionally go ape on someone. But I don’t think I did on this particular person– at least I didn’t mean to. I spend about an hour reading her note and writing back, so I found her reply to be a bit… annoying.

  3. I know (we all know at some level) exactly the place this person is at…and although I deeply empathize with how she’s feeling, I also know that telling her what she wants to hear will not help her.

    She wants to hear that it’s not her fault…she’s an addict and she’s sick and the medicine isn’t working the way it should. She wants to hear that there is another way to get what she wants and it is THIS. What she really wants, is what we all really wanted in the beginning! We want to wake up one morning and have our life be exactly the way it was before addiction dug in it’s heels. We want to believe there is a way,a special rehab, a pill, a prayer or a exercise that will do this FOR us. We believe addiction was just a bad CHOICE we made that we need to “undo” and if we can just get over the hump everything will go back to the way it was…..and we want someone to reassure us that this will happen and tell us HOW to make it happen. When someone tells us that isn’t how it works–we get upset and angry and defensive. We try to make them feel bad too. These actions prove how very NOT ready we are for our own recovery, because someone that is truly ready LISTENS to bad news (sprinkled with good advice) with an eager (but sad) ear and instead of getting angry, tries to figure out if it makes sense

    On one of the message boards I post on a lady wrote in and said she was going to jump off her medication immediately and to hell with the consequences. She was tired of having to take it every day, and she still wanted to use all the time and she still hadn’t been able to convince her family that it was a good idea–so she was going to get off the medication NOW and get ON WITH HER LIFE…????

    I wrote back that what she wrote showed how much she needed to stay on the medication for a little longer. Mostly because it showed how quickly she was going to relapse if she did go off the medication, but also because it showed how little she had learned from her addiction experience and how much more damage she was going to do to herself when she did relapse.

    IF she truly believed that she should (and could) have EVERYTHING she wants, exactly when she wants it and that addiction was as easy to “get rid of” as a case of the clap–then she had no true understanding or RESPECT for the damage and scars it brought with it.

    The people that come to the message boards and post that that they are doing a slow taper and need a little encouragement because they recently had to up their dosage a little to re-stabilize OR the people that say they are trying a taper, but understand it might not work out as they planned…..THOSE are the people I feel are finding what they need in recovery.It shows that they’ve realized that things don’t always go the way they planned or the way they wanted–but that they make the best of it and move on…..and to me that is what recovery is all about: making the most out of your life despite being an addict.

    The person that wrote this letter to Dr. J just isn’t in this spot yet. I can only hope that it wont take getting off Suboxone, relapsing and damaging herself further, to figure out what she needs to do.

  4. AMEN – I’m literally speechless by what I just read – and she told you PEACE like you’re some 14 year old out on the streets ACK!

    Well I think you’re great and don’t matter if you respond to my lil nothings 😉 as long as you know I’m still reading your blog and supporting you that’s what counts in my book!

    Oh btw I don’t think you were rude at all – you told the truth and I think ALL ADDICTS go thru periods in there life when they wanna quit so badly but then can’t and the cycle just keeps continuing until one day you really really really MEAN IT and that’s when YOU WILL BE GRATEFUL for a drug like suboxone not hate it daily – I hear so many ppl say that first few months are honky dorey then it’s hell they dying to get off this shit… and can’t believe what happens when they do get off it…

    well DUH!!

    I’m still in awe how great i’m doing on this drug – and I’m not stupid about it I know the consquences to my actions but I’m living life now to the fullest and man this sure beats chasing pills etc.. and being dopesick

    SIGH – Doc, sometimes you’re gonna have to brush ya shoulders off and just delete these comments/emails you get!!!

    anyway, I’mma keep on reading I’ve missed a few posts from you – busy down here in N’awlins :)