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.