Monday, November 22, 2010

Terminating Patients as Disciplinary Measure:

The following is an exchange that appeared recently on a international website linking colleagues involved in addiciton treatment:

Initial posting: I was wondering if any of you were aware of, or have come across any data/research/information that discusses how long any period of client exclusion from drug treatment service should last? This is in the context of disciplining a client who has transgressed while in treatment.

Response from USA (Robert Newman): forgive an unsolicited comment from far off New York: I wonder if there is any other field of medicine (let alone one with potentially life and death consequences such as opiate dependence) where patients are "excluded" as a "disciplinary" measure because of "transgressions". What "transgression" would lead a doctor to deny further treatment to a patient with tuberculosis, or severe asthma, or diabetes? Would failure on the part of a diabetic to adhere to a prescribed diet, signaled by "catching" a patient stuffing himself with pavlova and two scoops of vanilla ice cream on the side be a sufficient "transgression" to warrant disciplinary action in the form of therapeutic abandonment?

NOTE: I am very painfully aware that precisely these practices are the norm in most methadone "programs" in the USA. I've never heard of any program pursuing this policy being sanctioned by the federal or state regulatory authorities or by the agencies charged with setting and enforcing standards. But for sure that doesn't make any of this right.

16 Comments:

At 12:27 PM, Anonymous Jon mohan said...

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At 2:59 AM, Anonymous Anonymous said...

Thanks for the info. Dealing with addiction can be hard and you should have an intervention for people you love when they need the extra help.

 
At 1:52 PM, Anonymous Anonymous said...

Hi, was just reading your post on punishment in treatment programs. I feel pretty lucky to be in the doctors office I am in, I go every 2 weeks and pay $75 per visit(Induction was $145+$8 for the 2 subs given to me in office), $25 of that is to go for my urine screen. I am prescribed subutex. It really takes a lot for my doc to kick someone out of the program, he punishes his patients by hitting them in the wallet instead. If you give them a dirty urine, you are moved to once a week visits, where you are required to pay that $75 weekly instead of bi-weekly, so that is an extra $150 a month. It really seems to work. I chose this doc because of his low prices(other providers wanted $600 for induction, then $300-$400 per monthly visit) and his philosophy that kicking someone out of treatment makes no sense. Also, he doesnt punish for marijuana use, he doesnt encourage cannabis use but does not punish people for it. He is more concerned about illicit benzodiazepine use, he is really paranoid about the benzo use and the patients who do have a legitimate script for a benzo must bring their bottle of pills to each visit. I been going to this doc for awhile and I've only seen 1 patient that I know of get removed from the program and this guy was busted for selling his pills and was all over the newspaper.

To me, it doesnt make much sense to kick patients out of treatment if they need it, this is why I avoided methadone because of how strict they can be with take-homes and the fact you are like chained to the clinic. I'm also a daily pot smoker and I made sure I found a doc that didnt punish for cannabis use.

Good Luck to everyone out there fighting the opiate dependency fight.

 
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At 4:51 PM, Anonymous Recovering Addict said...

I am an opiate/benzo addict in recovery after a 43 year run and have seen several people in my 6 months of rehab "fall off of the wagon" and excepted back into the program as day 1 stage 1, more than once. I was not one of them but I can feel for those individuals who have fallen and want to get back up and try again. I takes a lot to of intestinal fortitude to stop using and make the commitment to a life of recovery. With that in mind, we are humans, with faults and suffer from a spiritual malady that can only be addressed through "Getting It". With that said, slips are a part of the recovery process and need to be dealt with firmly, but to drive someone out of a recovery program because of it is short sighted and, in most cases, detrimental to the recovering individual. Given enough of a chance, the addict/alcoholic will get it, some sooner than others.

 
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At 8:30 PM, Anonymous Adam said...

It's obvious to me that someone who "breaks the rules" is in need of treatment and while I understand the hard line many treatment programs adopt (they want to help those who want help) I think that kicking out of the program would be counterproductive. I think that there needs to be more thought put into figuring out how to "punish" those who habitually break the rules while offering someone else who has experienced a "slip" the opportunity to redeem themselves and continue treatment.

 
At 11:56 AM, Blogger Garrett McGovern said...

Patients paying for a urine test!! I thought I'd seen it all. What happens if the patient refuses to pay? Does that mean they get their treatment but no test? (I know, I know, wishful thinking).

In Ireland, it is bad enough that the treatment providers pay for the test. What is utterly soul destroying is the results of the test are used against the patient. As Bob says, there is no parallel in other areas of medicine.

 
At 9:25 PM, Anonymous R Johnson said...

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