tag:blogger.com,1999:blog-7772182113499451603.post441601336935634268..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: The NEJM "Addiction As Learning And Not Disease" ArticleGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-7772182113499451603.post-32096702901328091842018-10-23T12:53:23.062-05:002018-10-23T12:53:23.062-05:00I have been practicing for 25 years, and I have no...I have been practicing for 25 years, and I have not seen anything deter me from my paradigm about addiction, which is the following:<br /><br />there is a genetic basis to about 1/2 of the addiction population; there is about a 1/2 that is based on self medicating; there is about 1/4 that is about serendipity exposure to substances that leads to dependency, and there is about an 1/8 that is purely a sensation seeking model of use to seek out euphoric experiences. Yes, they add up to more than 1, as there are overlaps with these patients having more than one factor to their developing dependency/addiction. The Sensation Seeking folks are the ones who most likely can get out as unscathed as possible because they get bored with the addiction experience and move on to other experiences with some ease. The Serendipity folks seem to overlap with both the genetic risk group and self medicating group, but, they too seem to move out of addiction with some ease if not too embedded with a "support"system that sabotages their efforts to get out.<br /><br />The last two, the genetic and self medicating groups, why they are at least 1/2 the population of addicts each, more likely more than 50% for each, but, when they overlap, these are the multi factored group hardest to see maintain abstinence, because the genes AND the self medicating are so hard to reframe and commit to alternative models of stability.<br /><br />By the way, sorry for my more usual side bars, but, the Suboxone model has really deteriorated into Methadone 2.0, and frankly, even more heinous when one considers how much pure cash these providers are hauling in the way Suboxone is still being managed as of now.<br /><br />Where I am now, what a farce at hand, Suboxone providers are "mandating" patients see a therapist for psychotherapy to stay on Suboxone. HAH! They are just trying to find a scapegoat to legitimize these patients accessing other controlled substances the Suboxone Providers know they will get heinously gigged if they stupidly wrote for benzos and stimulants!<br /><br />Thank God I am I done this assignment in 5 weeks. Frankly, I cringe when I pick up an eval chart and see Suboxone or Buprenorphine in the intake section....<br /><br />...as these therapists want someone to bail them out from having to take these patients on alone!....Joel Hassman, MDhttps://www.blogger.com/profile/18428102819014299270noreply@blogger.com