In this life, everything should be as simple as it is, but not simpler. That includes this questionnaire study about marijuana as an “exit” drug for substance abuse. This article hit a nerve because there are issues here I have come up against before. And I mean “against.” I don’t mean to say it isn’t “good science;” it is. I’m talking about the emotional resistance to the idea that detoxifying from a medication can be comfortable, painless, and effective. I see this coming like I see the sun rising in the morning, because I have been to this place. A few years ago, I found myself in an informal banquet room across the parking lot from a hotel type establishment in a touristy part of San Diego. There was a woman rep from the drug company, Hythiam. She wasn’t an ex beauty queen like most reps, but a fairly credentialed therapist who actually knew what she was talking about. My husband was there with me; a younger, chubbier, and more naïve me – therefore, less authoritative.
These Hythiem/Prometa folks had a great schedule of IVs that removed physiological cravings for various substances of abuse, including methamphetamine. Basically, they use safe and older type drugs intravenously for a lovely pharmacological intervention. The cravings stop, and the person does not “need” to use the drug. Neither they nor I was stupid and naive enough to think that was all you had to do. Aftercare was important and I was ready to jump in. They recommended vitamins — I recommended lots of vitamins, high dose, and chelated to cross the blood-brain barrier. But these addicted folks needed “prosthetic lives.” When all you can muster goes to satisfying a craving or a need, there are not many hours left in the day for work or relationships. I helped with this, too. Some people had problems, but they were mostly because of the psychosocial void left when they did not go for drugs, and their inability to fill it. I worked my damnedest with these folks; and like the company, was eager to be accepted into the addiction community. There was this reception, and they had invited people from every substance abuse program in town. I was there and ready to go to bat as the only physician who had experience with these folks locally. Two people showed up. One was an older, fatherly type. The other was a young sidekick who was presumably learning from him. This older guy said something that rings in my ears now. “You got to earn your sobriety.” Read more on Time to Stop Judging and Start Healing…
Filed under medicine, News, Substance Abuse by on Jan 4th, 2013. Comment. 
The first time I heard about using empty whipped cream dispensers to get “high” was a long time ago. I was living at my parents’ house after I had finished medical school in France. I had done my thesis as quickly as possible, in the fall. My residency was projected to start July first. I promised my parents I would do what I could to earn my keep. I sold kitchen cabinet fronts over the telephone, got involved in a chorus production of “Pirates of Penzance,” and substitute taught for awhile.
As a substitute teacher in suburban Boston I was taught everything from senior hygiene to 9th grade algebra. A principal saw me teach 9th grade algebra and told me the heck with the credentials — the way I put across factoring quadratics was good enough for him to take me on permanently. I was leading the class in yelling, singing, and dancing “everybody factor.” And they were.
I told him I was going Cincinnati to start a surgical residency. He stared at me in disbelief. I told him I had more important news for him. Read more on Teens and Inhalant Addiction and — K2 Spice?…
Filed under Addictions, Education, Family, News, Substance Abuse by on Aug 30th, 2012. Comment.
California is known as “The Golden State” and some have called it “The Land of Milk and Honey.”
The Beverly Hillbillies noted that it was the home of “Swimming pools – Movie stars.”
That should be encouraging for people like my 27 year old, freckled, red-headed patient. After all, he had a pool cleaning business. But he was nervous — really nervous.
He did not have full-blown panic attacks, though he certainly fit the criteria for generalized anxiety attacks. Sometimes he did get a “heart in the throat” kind of feeling; something which some people would have called a “truncated anxiety attack.” But he had a lot of them and they really didn’t cramp his style very much.
He did not sleep very well, confessed that concentration was poor, and had great difficulty trying to find any interest in collegiate academics. As a result, his grades suffered considerably. And while I could potentially chalk this up to him falling into a category of males who may be better equipped for trade school than an actual 4-year college (based on patience; not necessarily intelligence), I didn’t believe this to be his case at all.
This guy was anxious. Read more on Stuck On The Treatment Treadmill…
Filed under Public Health System by on Jan 3rd, 2012. Comment.
Wouldn’t it be fun to just sit in front of the TV all day and watch your favorite shows?
Actually, it’s pretty darn depressing. Anyway, that’s what I have noticed, and now it’s official.
I cannot begin to guess the number of people I have diagnosed as depressed who watch television all day. I’ve noticed it for a long time, and part of my standard examination is to find out what people do with their daily lives.
Short answer – couch potato.
Most of the time these folks aren’t actually trying to change their lives or get better. This isn’t just a simple, “Oh, I gotta catch Jerry Springer!” or “Oprah is supposed to be good today!” Read more on TV And Depression…
Filed under depression, News by on Nov 25th, 2011. Comment.
Here are some phrases that you might not expect to hear sweet, friendly Dr. G use very often:
“No, there is no way in hell I am going to renew that prescription as written.”
“Read my lips. No more oxycodone. We gotta get you into a rehab, sweetie.”
“Sure, you can see another doctor. I don’t know how long it will take to get an appointment. If I am your doctor, you go on a tapering schedule. Today.”
“If I did what you want, I could kiss my license goodbye. I am not prescribing outside my specialty and certainly not this crap. Yes it is crap. I am sorry you don’t like how I talk, but it is crap. I can start getting you off it.”
These are all things I have actually said. Usually loud, yelling over the patient. Read more on Pill Mills Are Death Traps — Marginally Legal…
Filed under Addictions, prescription drugs by on Mar 28th, 2011. Comment.
Ahh – 19 years old! It is a magical age. At least it has been my experience in public mental health clinics.
You see, almost without exception any male of 19 years who appears in my office – is a really messed up and sometimes just, plain rotten fellow.
I don’t know what it is about 19.
One of the typical cases – though legally an adult — was functionally a kid, living with his parents and acting out the same kind of adolescent rebellion that most go through at 14 or 15 and out-grow by 17.
Oh, he had it all — One of those cylinders in his earlobe, spreading a hole from a small piercing to the size of a basketball. He told me it was “tribal.” He was a music major at a local, broken down branch of the state college. He wanted to be a performance artist.
Filed under Substance Abuse by on Mar 7th, 2011. Comment.
I have not been a chronic television watcher since early childhood, mainly because the projections on a two dimensional screen seem to be to be — at best — a weak distillation of the human drama that happens in my office.
Hamburger Helper puppet needs a helping hand -- in Rehab
But for my patients, I know well that the line between what they see on television and what they see in their living room is blurred at best.
I have, however, been compared to various TV shrinks — which I have been told is a compliment. The first person who told me I was like one, I asked why. When she said “because you always say the right thing.”
I was obviously flattered since you better believe I am NOT scripted.
Filed under Substance Abuse by on Feb 19th, 2011. Comment.
Full Disclosure – I don’t strictly spend my time-off at the opera or watching Masterpiece Theater or reading Proust in the original French.
thanks to technabob.com
Oh, I do have a wonderful appreciation for doing such things, but I also spend some of my time playing Tetris. Honest!
I won’t say I’m obsessive, but the game is really quite fun and challenging. However, I actually met what I thought was the first “tetris psychosis” I had ever seen. The 43 year old bipolar actually told me he was addicted to Tetris. Read more on Tetris Psychosis — It Could Happen…
Filed under Brain by on Jan 24th, 2011. Comment.
People who have panic disorder go to doctors to take care of it. I have had maybe hundreds of patients, more than I can count over my years of practice, who have come to me with this. Most of them do well. Usually the panic disorder runs its course.
That is not to say that panic disorder is not terrifying. Often people believe that their first panic attack is a heart attack. Often they have come to me already addicted to benzodiazepines by emergency room physicians who (understandably) worry a lot more about the immediate comfort of the patient than about the long term situation. Here is the official government take on panic disorder. Yes, find a psychiatrist you can trust. Yes, they recommend family and support groups. Good stuff, but free and easy to recommend. Yes, there is some exciting new research but as long as insurance companies and HMOs determine how people get treated, it is unlikely that research will be quickly translated into treatment.
Most people who go with the mainstream treatment do pretty well. Here is another description of mainstream treatment, a little more complete. Read more on A Real Doctor — Like House MD…
Filed under medicine, prescription drugs, Stimulants, Substance Abuse by on Jun 17th, 2010. Comment.
She was 33, blonde and attractively dressed. She had been stable on some medications for bipolar illness for many months before seeing me for a renewal. She told me her marital relationship was wonderful. They ran a little boutique together in the historic part of downtown. Not getting rich, but doing what she loved.
Only one problem — her husband said she became difficult when she drank too much coffee. I asked for some description of the “difficult.” She noticed she was nervous and had trouble cooling down later. She had “panic attacks,” which had not been a problem before.
They sounded exactly like the description of that disorder in DSM-IV – the one nobody likes applied to them – the “B” word. The things she said her husband had said about her sounded like the criteria for mania. No sleep, loud arguing, anger, nerves, etc. “Let’s look at cutting out the coffee,” I told her.
She normally drank as much as a half-pot in the morning at home before opening the boutique. That may not sound like much, but others have had similar symptoms from less. She had figured out herself that coffee in the afternoon messed up her sleep beyond description.
Caffeine has a LOT of effects on the body. If it had been a modern discovery, instead of the old myth about some frisky goat in the near east chewing berries off a tree and surprising a young shepherd by omitting sleep, caffeine would have caused the FDA a struggle to pass it because it does so many things.
First, coffee is absolutely NOT the only beverage that has it. There is generally more in caffeine-containing cola drinks. Read more on Caffeine As A Bipolar Trigger…
Filed under Stimulants by on Mar 8th, 2010. Comment.