Even though this little NPR interview with two addiction experts had a promising title of interesting subjects, What Triggers Addiction? How Can It Be Broken?, it was light on details because of its brevity. Of course brevity was what attracted me to it in the first place and I still found it a thoughtful piece. They covered a subject near the end of the interview on "choice" that I found particularly interesting because it so closely paralleled my own thoughts on the subject. You can click on the streaming audio here to pull up the player in a new window.
Click "Read more" to continue...
One issue they discussed that is a sore point with me is the Diagnostic and Statistical Manual of Mental Disorders, or DSM IV. The DSM IV is basically the encyclopedia of mental disorders used for diagnosis. Truthfully I didn’t disagree with anything the specialist said on this topic, it’s just that I feel some health professionals rely too heavily upon this resource. It's purely anecdotal, but my concern is about patients in treatment for addiction, many who report being prescribed a wide variety of psychiatric medications on the basis of short surveys based off DSM IV with little if any actual interaction from a doctor. This one size fits all method of prescribing medications is the very reason many of these people are in treatment in the first place.
Like I said though, the interview is an interesting little piece that maybe can add to your recovery program for the weekend, give you a topic for a meeting (or a DSM IV rant for me), or worst case scenario bring about a nap.
And as always, please, everyone have a safe and sober weekend.
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I also agree with your opinion of the DSM. I think those who are alcoholics and those with mental disorders (and I don't presume to have an opinion of whether the two are related) are too unique to fit into an type of narrow definition. The psychiatric community is just trying to make addictions and all mental disorders fit into neat little boxes. It does a lot more harm than good.
I was married to an alcoholic, who, sadly, still has not sought treatment. I now watch him suffer from a sideline. I just started a blog for people like me. I found that most of the blogs by spouses married to alcoholics were bitter and hateful. Yes, I did suffer, but he suffered (and still does) more.
when its up and running I'll give you a shout so that we can get you onboard.
You're raising a number of thorny issues at the same time, almost none with easy answers or good news. This will be from a provider perspective since we work with docs, including psych docs, on substance dependence (SD).
Yes, the rate of co-occurring psych disorders is high and it's difficult to tell which is the chicken and which the egg. It's really three or more layers with the SD, the co-occurring depression or whatever, and the underlying cause for the depression. All need to be addressed.
Most psychiatric counseling is not delivered by psychiatrists, who these days primarily prescribe meds and leave it at that. The counseling is now most often done by psychologists. And the "boxes" are driven by the categories of care that managed care organizations will pay for (follow the money).
Finally, the entire situation is going to become more difficult to navigate if and when universal coverage is mandated. Who is going to deliver the care for the millions of extra patients in the system? There's not a lot of talk by politicians about that because there are no easy answers.
If you're expecting customized care at a time when access to any care is going to be the issue, then you're probably in for a tough time.
There is good news in the treatment of addiction, but it will continue to be subject to the same issues that you describe. About the best you can probably hope for are somewhat "cookie-cutter" approaches that actually work.
good luck..
jim
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