I am a board certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association. I mention these things only to indicate that I have the ability and training to diagnose psychiatric illness and prescribe medications. And yet, I have spent most of my 22-year career trying to get patients off of medications or at least to reduce their number of medications to as few as possible. Reading Anatomy of an Epidemic (1) felt like a validation of what I have thought intuitively and experienced clinically for years. I have tried to convince every psychiatrist I know to read this book, but it is amazing how difficult that seems to be.
I believe I think the way I do primarily because I work in the field of addiction psychiatry and we are trained to think more holistically, addressing the mind, body and spirit of a person. We try to get people off of drugs, why would we want to get them on others? I have done outpatient psychiatry in the past and I am aware of how difficult it is to make an accurate diagnosis when someone is actively abusing drugs or alcohol. However, the number of physicians who make a diagnosis anyway and put people on numerous medications, attempting to treat the symptoms that may be caused or at least exacerbated by the drugs the patients have been abusing, dismays me.
For the past twelve years I have been privileged to be the medial director of an incredible, 90-day, inpatient, dual diagnosis treatment program for people with mental illness and substance abuse problems at the state hospital in Pueblo, Colorado. For a state that ranks very high in drug and alcohol problems compared to other states and ranks very low in funding for substance abuse treatment, it is amazing that this program has existed for the past 20+ years, funded by the State of Colorado. There is not a similar program in the country but there should be as we have shown that funding this type of treatment truly saves the state money in the long run. We are mandated to treat the people who have failed everything else and most have been in an average of 3 previous inpatient programs and at least one intensive outpatient program without success. All patients must have a chemical dependence diagnosis and a significant mental illness in order to be admitted. The program has 20 beds and we have a 4-6 month waiting list.
The courts refer approximately 75% of our patients as a condition of legal problems related to their substance abuse. The majority of these are facing a minimum sentence of 2 years in the Department of Corrections if not successful in treatment. With the severe budget crisis over the past several years, attempts have been made by the legislature to close the program. However, in 2009 we began a prospective outcome study to follow patients for a year after treatment to see how they do. We are still in the process of collecting data but as of December 2011, 105 had completed the one-year follow-up. Fifty-three percent of these were sober and doing well at the end of the year and 30% had been continually abstinent for the entire year. Only 19% had re-offended and were incarcerated. These are excellent outcomes for a population that is historically very difficult to treat and prior to this program had no real period of sobriety in spite of treatment and consequences. Last year we were able to use such data to convince the legislature not to close the program and they came up with an ironic but appropriate source of funding for the program. Currently a significant portion of our funding comes from medical marijuana tax proceeds.
This program differs from other substance abuse treatment programs in several ways that could contribute to better outcomes including: length of stay of 90 days; completely tobacco free; abstinence based (we request that patients be off all addictive medications for at least 30 days prior to admission including benzodiazepines, narcotics and stimulants); fully integrated substance abuse and mental health treatment utilizing several different evidence based treatment approaches including a modified therapeutic community, cognitive/behavioral treatments, cue-exposure, relapse prevention, exposure to AA and other self-help groups; as well as complementary treatments such as 5-point NADA ear acupuncture (2) , other energy therapies such as Thought Field Therapy and biofeedback. These are things that I hope to share in this blog.
1. Whitaker R. Anatomy of an Epidemic. Crown Publisher, NY. (2010)
2. Stuyt EB, Meeker JL. Benefits of auricular acupuncture in tobacco-free inpatient dual-diagnosis treatment. J of Dual Diagnosis 2006;2: 41-52.
Such ironies–as a psychiatrist you sepecialize in the knowledge of pharmaceuticals and yet you have dedicated your work to helping people not take them. And with such a difficult population–those are incredible results, unlike anything I have ever heard or witnessed.
And the irony of being funded with medical marijuana monies–I am glad you can do good with these funds.
Your program helps those who have struggled for years with addiction problems and they are weaving themselves back into society with the tools offered in your program.
Thanks for your blog and your efforts to lessen the numbers of Mad in America.
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AA and 12-step groups are cults that condition addicts to feel helpless over their addictions. I’ve been a little over 11 months sober now after 8 years of suicidal knock-out drinking. I regularly blew over .2, even as high as .29 while being arrested or at the hospital. I’d drink the equiv or 40-60 beers a day in liquor. Yet it was AA and the belief that I had a “disease” that fueled that whole addiction. I began drinking simply to cope with movement disorders caused by a childhood of neuroleptic drugging, but then when I had difficulty just quitting without addressing my problems, I was convinced that I had a hopeless disease and only God could save me in death provided that I followed the 12-steps and preached the gospel to other addicts. Nobody in AA is ever expected to be sober for very long. Even when addicts admit that a single drink will bring about months or even years of bingeing again, they still unanimously agree that it’s inevitable. “relapse is guaranteed, but if you can go 100 out of 365 days a year sober, then you’re doing alright.”, that’s the gospel.
I have no respect for state funds, of any state, being spent on services that offer 12-step programs.
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I feel sorry for you, “EAC”…Sorry you don’t know the TRUE history of AA, and the DISEASE CONCEPT of alcoholism. AA has never said that alcoholism IS a disease. Rather, they started saying that it works best for treatment purposes to think of it LIKE a disease. This was done to reduce the “blame-the-victim” mentality that was used as a weapon against drunks. Also, a cult tells you WHAT to think. The 12 steps of AA show you HOW to think. There’s a huge difference. Of course, I’m old-school, orthodox AA. And, the AA of today is not what it once was. I’m sorry for you.
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It may be so that for some kind of problems the disease model is guilt-reducing also for the allegedly diseased person him-/herself. This often is so for “depression”, and probably for addiction too. For other problems, like “schizophrenia” for instance it is not. Anyway, the reduction of guilt, and possible “stigma”/discrimination comes at a cost. If my behavior, addiction or other, is the result of a disease, some kind of power outside of my control, all I can do is turn to another power outside of myself (be it AA or the mh system) to manage the disease, while I myself remain the victim. Personally, having been a victim in the past, but also having “de-victimized” myself since (with the help of a therapist, I should add; there’s a difference between putting my life into the hands of others, professionals, an organisation, a belief, whatever, and taking it into my own hands, which doesn’t exclude that I ask others for help with this) I no longer find being the victim an especially desirable status. http://www.iraresoul.com/self_therapy_essays.html#10
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EAC, I agree with you that AA or 12-step programs don’t work for everyone but they have helped multitudes of people achieve and maintain recovery. Our program is not a 12-step based program, however, we do introduce our patients to AA/NA/Double-Trouble groups and the concepts behind AA so that they can make an informed choice about whether they want to utilize this as a support once they are discharged. I am sorry that you have had such a negative experience with AA. I usually encourage people to try out multiple meetings because they are not all the same and some groups are healthier than other groups.
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Multitudes of people… I don’t know. I don’t have the exact percentage right here in front of me, but I do remember that AA’s success rate is about 10, 12%. Good for the 10,12%, but what about the “rest”??? Also, why have people settle for less than what they actually could achieve, why limit everybody’s expectations by telling them that once an alcoholic, always an alcoholic, and all you can do is stay away from the booze (and this approach somehow reminds me of “once a schizophrenic, always a schizophrenic, and all you can do is stay away from stress”… )? Approaches that look at why people started to abuse alcohol in the first place, that acknowledge these reasons, as well as the fact that reaching for the bottle was all they knew to do in order to survive, and that help people find other, more constructive ways to deal with life than by numbing themselves out to it, have the potential to create true recovery, allowing people to enjoy a glass of wine for instance every now and then without them risking to fall off the wagon again. Why not aim for true recovery, for no longer needing to employ addictive behavior at all, instead of just replacing one addiction (alcohol) with another (AA), so to speak?
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As a Distinguished Fellow of the American Psychiatric Association can you help explain to me (us) the average psychiatrists thought process. Are they aware that they are causing massive amounts of brain damage and suffering? Do they not care? And, as you mentioned, why are they so opposed to books and studies like Mr. Whitaker’s? Thank you.
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Scott,I actually think that most psychiatrists are good people who are trying to help their patients by doing what they were trained to do. The problem lies in the training. I do think there has been a very strong focus on “biological” treatment and less training in “talk therapy”. Managed care with only 15 minutes per patient fosters the use of medications and the idea of a “quick fix”. The pharmaceutical industry has played a big role in education of physicians but on the positive side, most training programs have taken steps to strictly limit access of pharmaceutical reps to residents. It will take a while to see the benefit of this.
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Thank you for the response. I will however like to focus on the part “it will take a while to see the benefit of this”. Just know that for every day the biological paradigm of care is being used, people are being damaged and killed i.e., you have blood on your hands. I guess it is easy to be cavalier about brain damage and death when your colleagues cause so much of it. But, given that my research has lead me to the conclusion that American psychiatry is nothing more than a means to control society and population (eugenics), what is the rush?
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I would not go as far to say Elizabeth is totally complicit in this drug scheme because to fiercely fight this paradigm within the ranks of psychiatry is kind of career suicide. Nor do i want to pick on her and dissuade others from righting on this forum. Nevertheless, her answer is telling in her lack of urgency and understanding the gravity of the situation.
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Good questions, Scott Miller. I’m sorry that the frauds, quacks, charlatans & mountebanks of psychiatry will not give you good answers.
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The program sounds efficacious.
I have found in medical management, which involves holistic considerations to be responsible, that I too cut back on medication usage rather than adding more.
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You’re helping people get off psych drugs, and you’ve read “Anatomy of an Epidemic”. That’s all very nice, really, it’s a first step in the right direction, and it’s a lot more than the average psychiatrist is willing to do.
Anyway, I must admit that when reading your post yesterday what popped up in my mind was something very much (though not entirely, for the original visit me on Facebook, anybody who’s curious) like this: “I am a board certified human being and a distinguished fellow of humanity. I mention these things only to indicate that I have the ability and training to diagnose people as fools, idiots, stupid, ignorant,… oh and crazy, not to forget.”?! This, of course, is name-calling, and luckily, in most instances, people, although they may have the ability and training to practise name-calling, don’t have the right to diagnose, as in official diagnosis, somebody else an idiot, or crazy, or what is worse, just because they happen to perceive the other person in such a way.
In most instances. The exception is, if the name-calling part is a board certified psychiatrist. Then the name-calling magically is turned into a medical diagnosis that virtually can’t be argued, as it, because it isn’t scientifically verifiable, neither is falsifiable (!), may follow a person, officially, for up to the rest of their life, often with devastating consequences: except for the fact that psychiatric diagnoses have the potential to queer the pitch for people in regard to education, work, insurance, etc., telling somebody who, in fact, doesn’t do anything else but reacts to life, that this their indeed life-saving ability to react to life is a disease or a disorder (it doesn’t really make any difference whether you tell people it’s their brain that’s diseased, or whether you tell them it’s their mind that’s disordered) tends to, additionally, victimise, re-traumatise, and disempower the person, (once more) invalidating their experience. Sometimes people decide to off themselves upon having received this ultimate official confirmation that they are the ones who are “wrong”, insane, and not worth being listened to, and I can’t blame them for it.
Now I wonder how is it that you, while you seem to be perfectly capable of employing independent critical thinking when it comes to the drugs — and I couldn’t agree more when you ask why anybody would want to put people on mind-altering substances, when the declared aim is to get them off such substances — seem to be completely unable to apply the same independent critical logic, when it comes to psychiatric name-calling, aka “diagnosis”.
Let’s face it, and even one of the most biologically oriented colleagues of yours, Ronald Pies, admits to it: http://www.psychiatrictimes.com/display/article/10168/1402032 , psychiatric diagnoses do not fulfil the criteria a phenomenon has to fulfil in order to make for a valid medical diagnosis. — Never mind that Pies thinks, they will fulfil these criteria one fine day. That’s wishful (magical?… ) thinking, not science. — So, what exactly do you base your belief that psychiatric diagnoses are valid medical entities, and not subjective, culturally determined name-calling, and, which is even more, that there actually would be such a thing as an accurate psychiatric diagnosis on?
You’ve read “Anatomy of an Epidemic”, and that’s fine. But you still have a long way ahead of you, if you really want to be of help to people. As a next step on this way I’d recommend Paula J. Caplan’s excellent book “They Say You’re Crazy”.
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Props to you Dr. Stuyt. In defense of AA/NA, I can say in research I have seen multitudes of people (including family members) benefit from these programs. Often addicts attribute salience to drugs despite how harsh or fatal the consequences are; and this misattribution is predictive of the PFC’s inhibited control mechanisms. A simple glass of wine, no matter how “maintained” the addict is, can be incredibly dangerous as that one glass will overwhelm the nucleus accumbens (pleasure center) with dopamine, and create an overwhelming response, greater than that of any naturally salient actions (eating, sex, etc.)
Also, addicted individuals have shown structural changes (loss of volume) in the PFC that are analogous to the behavior changes of impulsivity and failure to modify behavior. Despite whatever treatment route is taken, including pharmeceuticals and cognitive-behavioral therapy, the brain cannot fully recover the loss of matter, and an addict, like any other sufferer of a chronic disease, has to be mindful of their behavior if they want to prevent relapse.
An addict is by no means a “victim,” and programs like AA/NA do not purport this. But they must learn the coping and behavioral modifications to maintain a sober life, and re-attribute salience to positive, healthy reinforcers. Just as a person suffering from chronic migraines to diabetes, they have to adjust their lifestyle to account for the chronic disease they are consciously keeping in remission.
Also, if you’re aiming for “true recovery,” then you must understand a true recovery for many addicts would be drastic structural changes to their brain via medication. Behavioral therapies can only go so far, but the chemical and structural make-up of an addict has a large influence on the success of their treatment.
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Why would anybody have to make “drastic structural changes to their brain via medication” in order to liberate themselves from addiction? A statement like this implies the claim that the brain is the ultimate power in our lives. Is it? Or is there maybe something more powerful than brain structure and chemistry? Something within ourselves that actually has the power to change, among many other things, also brain structure and chemistry?
Denial of the existence of consciousness is the recipe for victimization.
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I’m late to this post, and I don’t mean to be rude, but I’m confused.
Your program is “mandated to treat the people who have failed everything else”, but it won’t accept people who fail to stay off the drugs/alcohol for 30 days? If they’ve failed everything else already, how can they reasonably be expected to stay off drugs, on their own, for a month? I can’t help but think that one additional reason for your good outcomes is you simply exclude the people who are more likely to have poor outcomes.
I noticed this paradox here because while I don’t have drug/alcohol issues, I have a slightly parallel issue: I have some nervous system regulation issues that different professionals have said I need to first reduce, before I can start using their favorite techniques to help reduce. I guess I’m not doing better enough to successfully use their approach to get better.
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The very last straw for me with psychiatry is when they wanted to give me a “dual-diagnosis”. They were hell-bent to believe that I was hiding a drug problem. I told them straight out that I’d never done certain drugs, such as cocaine or pills like ecstasy, oxy, etc.
Because I was seriously underweight (skeletal) and “in the eye of the storm”, they thought I was on drugs. I was literally starving because I was so emotionally sickened that I had no appetite and couldn’t eat. I would often have to force feed myself (extremely painful). They didn’t listen to a word I said, because they were brainwashed to NOT listen to me. They listened if I spoke about sexual things, abuse.
But I was not worthy of their respect. I was to be commanded by them, and the only “truth” is what THEY said it was. As far as I am concerned, you are all human beings and your titles are nothing. I strip them from people. You’re only a human; a man or woman. You’re not a “doctor” in my eyes. You’re not a “nurse”. You are not a “judge”. You’re not a “professional”. Truly, I am nothing and so equally are you.
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