most people don’t like subtance abusers. i daresay substance abusers don’t like themselves either. it is difficult to split the ensuing personality changes that drugs wrought from the person herself. these are some of the most manipulative, insulting, demanding and unpleasant individuals that you will meet. their one purpose is to use.
they come to the hospital when they are crashing / high seeking help but only for the moment and when the danger zone is over or the cravings began in earnest, off they go – like a stallion through the Arabian deserts. they rarely consider anyone other than themselves, choosing to destroy every possible therapeutic relationship – leaving in their wake misery, confusion, anger, bitterness and guilt.
these are the people who sell their soul for a hit, a line, a shot. their lives are brimming w/ unspeakable horrors – from bodily violence to others to their own sexual exploitation – they live, dream, eat, breath, poop for the next high. what miserable lives they lead!
why do they do what they do? why do some people become addicts and others walk away after one hit? some theorize that defective coping mechanisms learned from infancy play a part, some espouse traumatic life events as reasons for future dependence while others have thought that indigenous neurochemical imbalances adversely affect a person – rendering them more susceptible to addiction.
and we – the few, the proud, the psychiatrists – are chosen to help them. b/c we understand that for whatever reason that our patients have chosen a life of pain and misery, their thoughts, words and actions are warped by the presence of the drug. does that excuse their abominable behavior? no it doesn’t. but it brings perspective. and with perspective comes a greater deal of stoic compassion. the knowledge that no matter what type of person, what trauma befell them prior to using, now much of their behavior is directed towards the getting and using of drugs. the inherent nature of the drug will morph them. that is a fact.
we have medication cocktails (Ativan tapers, Clonidines, Seroquel for sleep etc etc), motivational interviewing techniques, outpt programs, inpt detox, rehab and countless other ways to facilitate their transition from living nightmare to healthy living. yet, not all of us chose to interact with them. of the many psychiatrists who treat mental health, only a small subset go on to treat substance abusers. why? b/c it is not easy. it takes a special type of individual to daily interact w/ such a group of people. i am not one of those special individuals.
tonight i was called to see a young man, early 30s, attempting to go through a professional licensure process but dependent on alcohol and cocaine who has not been able to pursue his goals b/c of his drug seeking and using. he had thoughts of self-harm. i was called b/c, having signed voluntarily, he wanted to leave AMA. he was cranky, verbally abusive, mocking, derogatory, defensive and resistant. unable to intimidate me or get a rise out of me, he became more and more pissy and when i informed him that he would not be able to leave until the main treatment team evaluated him he smacked the water pitcher off the shelf onto the floor. he cursed at me and as i walked away, i informed him that his actions were not gentlemanly at all.
what he doesn’t understand is that his behavior does not lend itself to discharge. he thinks that by raising a fuss he will be heard. after all these are behaviors that grant him some measure of satisfaction from others – on the outside. but not here. truth is, the longer he acts out the more visible reasons we have to keep him as a danger to self or others due to impulsive, unpredictable behavior. he doesn’t get that i’ve seen hundreds and my attendings, thousands of people just like him. we have accumulated data on his behavior and in the construct of the situation we perceive more than he can or is willing to perceive now. but he doesn’t know that.
he lashes out at me, never realizing that at the end of the day, I LEAVE. i take my white coat off, settle myself into the car and drive off to have dinner with a friend, attend wednesday night church services, see a movie, rest my weary self. i may think of him but i am not him. i am neither in a psych unit of the VA or at a separate psych hospital. i go home. i live my life. i leave him. but he stays in his nightmare.