I have chosen to put this under medicines management, because there is no where else I could put it.
All of us - perhaps with the exception of industrial pharmacists, come into contact with substance misusers. How many of us have thought when giving out the methadone, buprenorphine, acamprosate, etc, "could this situation have been avoided - could this patient stop using their drug of choice, and lead a "normal" life?"
I have to say that from my reading that sadly the answer is no!! True substance dependence comes from a variety of sources, the main one being genetic - ie substance dependence as defined in DSM-IV TR (Diagnostic and statistical manual of mental disorders:DSM-IV -4th ed. text revision, American Psychiatric Association 2003) p 197.
I read a number of Journals on Substance Misuse, one of which is Alcohol and Alcoholism, and I came across the following reference:
Emmanuel Pinto, Jean Reggers, Philip Gorwood, Claudette Boni, Gabrielle
Scantamburlo, William Pitchot, and Marc Ansseau
The Short Allele of the Serotonin Transporter Promoter Polymorphism
Influences Relapse in Alcohol Dependence
Alcohol Alcohol. 2008 43: 398-400; doi:10.1093/alcalc/agn015.
http://alcalc.oxfordjournals.org/cgi/content/abstract/43/4/398?etoc
OK it's a bit abstruse, but it points to a "hard wired" reason for why you never see any "reformed" addicts in your practice. The addicts you have now will be with you ten years from now - assuming that death does not supervene. Addicts or susbtance misusers cannot help it, they are programed that way. The paper I have cited above is just one of the many that i read, leading to the conclusion that substance misuse (or addiction) is something that is not a moral failure, but something that is there with the patient for ever, something that happens not on a "global" scale, but on a molecular scale. Something the patient cannot help - they are born that way. So can I ask fellow pharmacists, to treat these people as patients, and not as mis-fits?
Regards
Bob Dunkley
Addictive behaviour
Substance Misuse
Bob,
While I agree about not treating people as mis-fits - I don't thing your argument about genetic hard wiring has anything to do with it.
Why don't we see reformed addicts in our practice?
It's simple - they don't come in with a neon sign over their head saying "reformed addict" - we don't recognise them.
They don't come in as often as the unreformed addicts - there's no reason for them to do so.
Fairly often - once they are reformed they want to break with the past - and choose to use a different pharmacy for their other needs.
I wont deny a genetic predisposition to addiction - however to say that addiction is therefore inevitable and uncurable is going too far.
How do you explain the relative success in treating nicotine addiction?
If you want to see recovered addicts - pop into your local DAT units - they are often working there or in voluntary organisations within the field.*
I would also like to question the presumption that substance dependence is a mental health problem.(From the definition you quoted and where it's hidden in many on-line resouces such as CKS). Once it's defined as a mental health problem - it pushes treatment thoughts towards control rather than cure.
As for the data - I'm not sure how much of the data that is collected and used as evidence is as a result of treatment and how much is a result of addiction.
*The definition of recovered is interesting - many would forever describe themselves as "in recovery" - also working/volunteering within the field in addiction could be the result of a 12 step approach to treatment.
Jeff
Substance misuse