The lies behind the mask of addiction and how the health system plays into it.

     This subject can be very challenging, so the most important things that professionals should address is to make sure that these mental disorders are not mimicking substance abuse or addiction.  Doweiko (2012) explains some of these challenges.  A health care professional needs to be able to know the differences between symptoms of a mental disorder and problems that are occurring because of SUD’s.  He further explains that patients that mention a substance abuse problem will have the same signs as someone that is battling mental illnesses.  Some of the problem areas will be reduced or subside after the person remains clean.  Doweiko (2012), addresses that it can take up to two months to accurately diagnosis someone with dual disorders.   We can be left with a dilemma of a misdiagnosis, if the patient is not willing to admit to SUD problems.  Before diagnosing these problems accurately it is very important, because people can be exposed to medications that they do not need, and also a label of mental illness on their medical record.  Extreme caution should be taken before drawing a conclusion about a dual diagnosis (Doweiko, 2012).

     Anxiety disorder is one that can be mimicked by patients if there is not a correct evaluation made.  Doweiko (2012), again expresses the importance of proper diagnosis to know whether or not the symptoms are from the SUD or the mental disorder.   Doweiko states “one symptom of alcohol syndrome is anxiety” (p. 323).  It is more proper to examine patients for at least three weeks of abstinence before the proper diagnosis can be evaluated correctly.   If the anxiety persists without a substance than most likely the patient will have an anxiety disorder. (Doweiko, 2012).

     Bio polar disorders can also be mimicked if there are signs of amphetamines, alcohol, and cannabis, and manic expressions or depression can follow withdrawal from these compounds.  According to Doweiko “The relationship between the bipolar affective disorders and the SUDs is quite complicated”. (p 325)  He further explains that clinician have an accurate history of the patient in order to determine whether the symptoms worsen or started after the patient began to abuse drugs. (Doweiko, 2012).  It is of the up most importance that a complete work up of mental history is done on the patient.  If a patient has a long history with SUD’s there might not be a way to determine dual diagnosis.  In the case of depression it can be extremely difficult as well, because these problems could be a mask because of the SUD’s. (Doweiko, 2012). 

     If someone goes into outpatient treatment and complains of anxiety and have been using drugs and are not being honest, we face a mis diagnosis of this patient. Could the medical model be giving drugs to people that really do not need them? Could it be a factor of enabling them to self medicate. There is a growing problem of addicts playing the system. I know three of them that do this on a regular basis, and have even laughed about the medication they receive while nothing is being addressed about the real issues of their SUD's. Doweiko (2012) also addressed the mislabeling of someone and having it permenately on their medical records. There are most definitely serious dual diagnosis, but I have to question after finding out the lack of training in the medical model concerning SUD's if we are making to many mistakes. In many of the MHMR clinics people can walk off the street and go in to get a diagnosis and walk out with drugs. There are lots of these patients that are simply wanting to self medicate. I pray that we find a way of getting proper evaluations of these people so we do not become enablers of what we are trying to treat. 
      

     I know this is very important, because I have dealt with addicts, and have seen situations to where they will go into a clinic and fifteen minutes later walk out with a hand full of prescription drugs.   If an addict wants to self-medicate or cannot get their drug of choice, it is becoming a problem of working the system, because a proper diagnosis is not being made.  This is an extreme problem, and according to the research I read this week, it is very clear that proper diagnosis should be made before evaluating a patient and it can take up to several months if there is a substance abuse problem that has been addressed.  The biggest challenge is how to correctly diagnosis someone that is hiding behind there substance abuse problem.  If medical personal are not getting the proper training in this area, how can we be sure we are not self-medicating drug addicts and worsening the problem?  This is a question I ask myself daily, and wonder why changes are not being made.

 References:  Doweiko H. (2012) Concepts of Chemical Dependency Eighth Edition   

 

    

    

Model of Addiction

Models of Addictions

Medical Model of Substance Use Disorders- According to (Doweiko, H.E., 2012) medical model addresses assumptions that there is a possibility of disease, and it further results in biological upheaval. As the environment presents itself, it can trigger genetic factors in theperson that could be inherited. E.M. Jellinek is the majority of the reason that alcohol was accepted as a medical disease. Jellinek addressed alcohol in four different stages. 1)Pre alcoholic stage: known as relief drinking. 2) Prodromal stage: blackouts and guilt overdrinking. 3) self-esteem suffers and social functions are avoided that do not cater to drinking activities. 4) Chronic stage: destruction of morals and tremors. Doweiko (2012).

     Doweiko (2012) further states “there is no single, universally accepted disease model of SUDs. The medical model is loosely associated with numerous theories, and many have suggested that our fate is tied to genetics, but genetic inheritance does not define our behavior. If this were the case there could be no responsibility placed upon the behavior of the abuser. A person s environment and personal experiences can determine whether genetic occurrences will kick in. External forces can be a determining factor as well.

     It may signal relief to place the responsibility of the problem on genetics. We are still in immature stages of being able to evaluate genetics relating to the risks for psychiatric illnesses. According to Doweiko (2012) he further states that it is foundational ignorance that the medical and, psychological professionals speak out about patient’s genetic makeup towards addictions as if there was little hope, as if they were destined to develop a disorder with the lack of knowledge we have about biogenetics. Further critics of the pharmaceutical industry such as (cited Breggin,Peter, 2008; Doweiko, 2012) stated:

Healthcare providers and the general public have been bamboozled by much advertised speculations that brain scans can demonstrate the existence of mental disorders, or even diagnose them. In reality, no psychiatric disorder is demonstrable or diagnosable by brain scan, or by other medical or biological tests.

     Doweiko (2012) further addresses that healthcare persons understanding is that a disorder exists inside an individual. This is a false illusion that is not being represented, and it is allowing for misrepresentation that biological factors redeem excuses for behavior that is unacceptable.   Biology being an excuse by health care professionals. This leaves no accountability or hope for change.

     A personality model of substance use is a theory that there is an addictive personality. According to Doweiko (2012) this arose during the 20^th century in the beginning of psychoanalysis that had to do with hidden trauma that may have caused a person to turn to alcohol or drugs. Doweiko (2012) stated “Psychoanalytic writers hold that individuals used alcohol to numb themselves to emotional pain”. (p. 348) it is considered to be positive reinforcement, pleasure or euphoria, and also helps to deal with bad emotional states.

     Substance Use Disorders: The Final Common Pathway Theory. When using substances there rewards from the drug diminish over time and the increase of the drug is needed to satisfy dopamine levels. If the pleasure grows to boredom other compounds are sought out to increase the euphoric feeling according to Doweiko (2012). Eventually the drugs overwhelm the brains

reward system, and this causes it to fire enormously after using the drug. Disease model seems to be dominate in the United States. There are many insights as stated by Doweiko (2012), but all of these approaches are unable to explain the complexity of SUD adequately.

     While we know there are some biological factors that consist with this viewpoint, there is entirely to much medicating or allowing the person that is addicted to believe they will be this way their entire lives. If we treat based on medical models, everyone with the problem with a mental disorder and substance abuse problem will be treated with psychotropic drugs, which in fact is what is happening today. While I do agree with temporary treatment, medical professionals are not trained in the field of addiction, so this limits them to medicating. The medical model leaves out the hope of change from addiction.

       In AA they address their meetings that I am Jane Do and I am an alcoholic. This however does not mean that Jane will stay in that addictive state, nor does it mean that all people with mental disorders will be inprisoned to that state of occurrence. This medical model is bandaging the problem and not cutting it at the root. There is power in redemption and also hope and change outside of the biological genetic aspect. Most in the profession of psychology have little training on dealing with substance disorders. Now that the prison systems are so full and most of them have substance abuse disorders medical models enslave them with the theories of the disease model. I think our society has suffered greatly in our culture here in the United States because of this. Also the United States is preferenced to the medical model, and over the past years it is not proving it's success.

       I agree that we are in a debate of nature, nurture and spiritual examinations here, and I hope that testing will be done on other groups to determine ways to live a free life and not one that is weighed down in the prison system or meds, because it is creating one of the worst problems within our society. I am not biased to the medical or genetic problems, but the disease model has not proven to be effective on the National level. There is redemptive work that goes to the center of the root, and we do not only have to treat this problem medically, but I believe the problem for many can be cured and that is the path that is hopeful among Celebrate Recovery groups that have had high success rates dealing with addictions.

     To grasp the best of these concepts and use what resources that are available. The United States is biased to the medical model and this is very discouraging, and there is a growing need for substance abuse counselors like never before. Jesus Christ was the greatest of all Cognitive teachers and it is my believe if we follow his model there can be healing of the sick and a cure for addiction. Once again I would like to express I am not ruling out the medical model, but we need to move forward with other ways that could be more helpful that will lead to lasting results.

     Addictions result from the degrading effects of sin on or in creation. This includes the self and the sin of others and the world. The body is in need of redemption. We are not in a glorified state yet, and that leaves us in a vulnerable state to all kinds of things. Full healing can only be found in Jesus Christ and his redemptive work. (Clinton, T. 2005)

References

Clinton, T. (2005) Caring for people God's way; A New Guide for Christian Counseling

 

Doweiko, H.E. (2012) Concepts of Chemical Dependency (8^th Ed.)