By John E. Carey
Peace and Freedom
January 8, 2008
We are facing a crisis of drug and alcohol addiction in America. Most experts agree that about ten percent of our population of 300 million people are addicted or routine users. Many more family members, friends, co-workers and employers suffer harmful consequences – and our medical establishment is strained by people suffering from addictions.
On January 1, 2008, in almost every hospital emergency room across America, at least one or two individuals could be found suffering from Delirium Tremens (DTs), milder tremors, seizures and other alcohol and drug-related overdose symptoms.
My friend, physician and recovering alcoholic Len, took me for a post-party tour of a big city hospital emergency room on January 1.
“Look at the carnage following the biggest annual drinking binge Americans wink at every year. It will look like this the Monday after the Super Bowl, too,” Len told me.
In fact, experts say “Super Bowl Sunday” is the biggest day for drinking in America because it is an all day party. Most police agencies issue more tickets for impaired driving on “Super Sunday” than on any other day. And the Center for Science in the Public Interest claims that beer and alcohol advertizing for the Super Bowl targets underage drinkers.
Len invited me into his work environment after reading a Washington Times commentary I wrote for the December 27, 2007 editions. That article discussed the time of year when many recovering alcoholics and drug abusers relapse and end up in the hospital: the “holiday” season between Thanksgiving and January 1.
“For all sorts of reasons, many of the addicted who are in recovery and making progress crash and burn during the holidays. I think the pressure and chaos of buying too many presents and acting like a boy scout drives some in recovery back into really bad and sometimes fatal habits,” Len said.
Len is a recovering alcoholic who attends daily Alcoholics Anonymous (A.A.) meetings. Len is not his real name. We agreed to protect his anonymity in keeping with A.A. traditions and guarantees. As an emergency room physician, Len has gained invaluable insight into the disease of the mind called addiction. He is also an expert in how many of his colleagues treat alcoholics and the drug addicted.
“Most physicians I know are first rate. They care deeply for their patients, spend the time necessary to provide excellent care, and operate fair and honest practices,” Len told me.
But once Len finished with what sounded like an American Medical Association (AMA) commercial, I told him I had personally seen some sloppy, even potentially criminally negligent “care” of the addicted doled out by his MD colleagues.
Two patients seeking emergency care for bouts with alcohol were not admitted to emergency rooms while I researched this topic. They were told to make an appointment for ten days to two weeks into the future. For some: this poses a life-threatening dilemma. We also experienced physicians mis-prescribing and over prescribing drugs and medications to patients they knew to be addicted.
One doctor had his sleepless patient on Ambien for two years. The maximum recommended duration of Ambien therapy is one week. Ambien is addictive. Withdrawal symptoms include behavior changes, stomach pain, muscle cramps, nausea, vomiting, sweating, anxiety, panic, tremors, and seizure (convulsions).
The Food and drug Administration (FDA) warns doctors and pharmacists not to prescribe Ambien to alcoholics or other addicts.
We also saw doctors giving Xanax to drinking alcoholics to relieve anxiety. Xanax relieves anxiety in people who do not drink: but it is never recommended for heavy drinkers. This medication may cause dependence. Addicts frequently react violently to the drug and vomit sometimes for hours after taking it and experience other distressing and even life-threatening side effects.
We met a man who went to his doctor two years ago with severe anxiety symptoms. Today he rarely ventures out from his one-bedroom apartment. There are three deadbolts on the door. He has five physician prescribed drugs delivered to his apartment when he needs refills. He is no longer able to work. He is lost as a productive member of his family and our American society.
“There are doctors in America who are killing alcoholics and drug abusers because they haven’t properly availed themselves to the literature and education needed for treating the addicted and they pay too little attention to the warnings associated with all medications,” said Bill Alexander, who manages a private drug and alcohol rehabilitation facility in Oklahoma.
We also observed a clear disregard for many addicted patients: an attitude and actions akin to racial prejudice. Alcoholics and others are frequently looked down upon and can be viewed as “winos” or other disreputable types not worthy of full and complete diagnosis and care. If the addicted man or woman seeking treatment causes the doctor to become unsettled, the doctor might quickly end the evaluation phase of treatment and hastily write prescriptions for pain killers, sleep aids and other drugs.
“Some doctors, but clearly not all, cut corners. They reach for the prescription pad too readily. They under evaluate and over-prescribe. They are in too much of a hurry. Even when the vast majority of care givers to the addicted advise doctors to first consider a cold-turkey detoxification – without the benefit of additional medications,” said Dr. Len.
“We doctors write prescriptions sometimes even when they are not mandated. Insurance companies pay most of the cost and the doctor feels that he has taken action on behalf of his patient. Some have even told me, ‘I gave the patient exactly what he wanted.’”
The patients, because they are addicted, often act irrationally and not in their own best interests. They self medicate, over medicate, and “shop” for agreeable doctors willing and ready to help them get their “fix.” Addicts are risk takers – and even knowing that buying drugs below cost and on the street probably means the drugs are impure, dangerous or otherwise filled with a foreign country’s idea of a money-making substitute – they often use and abuse until death.
Despite the herculean efforts of an army of diligent care-givers and treatment facilities nation-wide, many alcoholics or drug addicted people are misdiagnosed, living on the streets, ignored, abused or shunned. Treatment facilities and in-patient care is at maximum capacity with no room for new comers. And the care of medical professionals is stretched thin.One doctor told us, only after asking for anonymity, “You’ll be lucky if this man can see a physician’s assistant or a nurse. There are no doctors available.”
And more doctors may not necessarily make things better.
“Calling for more doctors, like prescribing more drugs, for an already overmedicated patient, may only make things worse,” said Dr. David Goodman, a professor of pediatrics and family medicine at Dartmouth Medical School, which researches heath care quality and costs.
He says as the American population grows and the “baby boomers” enter their retirement years, more doctors writing more prescriptions and seeing more patients only escalates the costs of an already exorbitantly expensive medical system. He favors more study and analysis before anyone jumps to conclusions on how to solve the multi-faceted dilemma of our medical system’s future.
Between the end of the holiday season and “Super Bowl Sunday” might be a good time to start to re-assess America’s response to a growing number of alcoholics and drug addicted people in need of treatment.
We can ill afford to ignore or “write off” the ten percent of our potential productivity, scientific development, and artistic and creative wonder that this segment of our population represents.
John E. Carey is a frequent contributor to The Washington Times, a former senior U.S. military officer and president of International Defense Consultants, Inc.
Overprescribing and overmedicating are common problems.
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