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
