From: hounddog23x@gmail.com   
      
   A physician enters rehab. What happens next should disturb you.   
   ANONYMOUS | PHYSICIAN | JULY 4, 2015   
      
   shutterstock_223709917   
   I'm a physician, and I'm adrift. I am pretty much lost at sea. I've often   
   thought of writing this column, but afraid I'd be recognized, I've hesitated   
   for years. Even now, I'll most likely remain anonymous, because I'm in a   
   vulnerable position. Let me    
   preface my remarks with the reassurance that I'm not a bad person.   
      
      
   I developed dependence on opioids several years ago, after I had a traumatic   
   injury.  That's not uncommon in America: Approximately 20 percent of Americans   
   meet criteria for substance dependence at some point in their lives. I'm   
   pretty average in many    
   ways.   
      
      
   After my injury, emotional upheaval ensued, and I continued to take   
   hydrocodone to relieve anxiety and fear. I didn't take it at work, so that   
   issue is off the table. I realized my growing need and limited legal supply,   
   confiding in a colleague who    
   turned me into the physician health program in my state. The process that   
   evolved left me in disgrace and without a job, despite the fact that I haven't   
   taken a drug in many years.   
      
      
   I'm not certain where my path diverged in a direction from which there's no   
   return. I had already sought help, and I was on opioid maintenance treatment   
   when the physician health program (PHP) became aware. I went to the "approved"   
   evaluation, spending    
   down my bank account rapidly for what turned out to be a PHP seal of approval   
   diagnosis. The director of the center where my "evaluation" was performed was   
   candid. He told me that as a physician, I could expect three months of   
   inpatient rehabilitation in    
   a 12-step program that was also on the master list. However, he noted that my   
   evaluation could not include treatment recommendations, since the PHP already   
   had my "individual" plan mapped out. Contrary to American Society of Addiction   
   Medicine    
   recommendations, the severity of my addiction and other aspects of my   
   dimensional assessment had no bearing on "patient placement."   
      
   We're not as rich as we once were as a profession, so I think it's safe to say   
   that the $60,000 fees for evaluation and mandated rehabilitation are onerous   
   for many, quite apart from the time away from work. Separation from family is   
   also difficult,    
   particularly when effective treatment can be achieved close to home. ASAM   
   criteria suggest the least restrictive form of treatment consistent with   
   patient safety. I had an effective physician, licensed by my own medical   
   board, but those credentials weren'   
   t adequate.   
      
   The price paid in dollars, reputation, and emotional upheaval in the family   
   might have been justified if these treatment centers had a record of success.   
   Unfortunately, without monitoring and contingency management, there's no   
   evidence that physician    
   health programs achieve more than the abysmal rates of remission seen with   
   non-MD clients.  We are trained as scientists, but we accept flawed studies   
   that have confounding variables to bolster our treatment mandates for fellow   
   doctors. During this    
   period of time, I met the director of our PHP. It seems he had undergone the   
   same treatment -- multiple times. If someone has a urinary tract infection   
   that doesn't respond to Bactrim, we will not repeat another course of the same   
   drug.  It's time to    
   insist on rigorous evidence before we ruin additional lives.   
      
      
   Although Alcoholics Anonymous and its many spinoffs do not have a record of   
   success, my medical licensure was contingent upon participation after rehab.   
   Monitoring poses no problem. Although I admit to having the occasional   
   alcoholic drink without    
   experiencing the promised descent into the hell of alcoholism, I could have   
   tolerated monitoring for five years. However, without constant and obsessive   
   AA attendance and a relationship with a sponsor that was contingent upon   
   talking about something I    
   had no interest in discussing ad nauseum, the PHP claimed I would not be "in   
   recovery."   
      
   The vocabulary in play is hard to pin down. There are variations and more   
   variations. We are told addiction is a disease, but we send addicts to   
   treatment centers where they are told they have a moral deficiency. We achieve   
   remission, but then we move    
   the goal to "recovery" when it results in a greater revenue stream from a   
   captive population. It's not coincidential that the recommendations for   
   extended treatment time have come from the same "addiction specialists" who   
   benefit financially. Sadly,    
   despite 14,000 addiction treatment centers in the country, we have more   
   addiction than ever before, and it's increasing rapidly.   
      
   The required "spiritual awakening" never happened, and I failed    
   ehabilitation, after I acknowledged my reluctance to participate in a   
   religious program as my "cure." I'm sorry, but I'm not religious, and I don't   
   think that was part of my Oath.     
   Prisoners cannot be forced to participate in these religious programs, so I   
   fail to see why physicians must declare a willingness to let an unseen being   
   control our lives as a condition of our licensure. Yes, I "get" spirituality.   
   This is not a theocracy.   
    There are other civil rights violations in play, including use of lie   
   detector tests to ferret out additional "addictions" that can be treated.   
      
   Ideally, I would never have turned to a chemical panacea. In reality, I have   
   been marginalized by a system that makes no sense at all. The research is   
   widely available. The appeal to authority is an invalid argument for the   
   process in which many are    
   forced to participate, but it's widely accepted, although the authority is   
   fatally flawed. Rationally, many doctors who take drugs and remain   
   undiscovered will remit spontaneously. Those who come to light, for whatever   
   reason, are ruined forever. We    
   worry about doctor suicide, yet when a colleague comes to us for help, we   
   often increase their burden through a process that benefits no one except the   
   community of addiction professionals who continue to profit from self-referral   
   and creation of new "   
   standards of care."   
      
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)