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View Full Version : Medical Model & Narcotics Anonymous Model: Separate Focus and Powerful Partnership



Dr. Joel Nathan
03-15-2009, 10:12 AM
There is a distinct separation from N.A. and medical management of addiction. To my knowledge as an Addiction Medicine doc, N.A. members are part of a spiritual fellowship in which they gather to support themselves in their personal recovery. Each member shares his own personal story of recovery. N.A. Members are not at the meetings to provide medical advice. Sometimes if medical advice is given by a non-professional this leads the N.A. member to stop medications that are actually helping them.

A doctor’s opinion differs from the N.A. opinion. It is important to note that few docs are actually trained in med school about substance abuse or its treatment. I've been in the addiction field for a while and have taught med students and other docs about substance abuse treatment. The information is getting out there, but it's a slow process.

Addiction is a disease and is chronic and relapsing, just like diabetes or cancer. Addiction is incurable, but is treatable. One can feel great and be healthy in every way in recovery. If you have an addiction concern, you can seek out physicians and therapists who have specialized or have a personal interest in this area. You will be treated with respect by these clinicians.

Doctors are trained to see a spectrum of an illness. I have an interest in both the abstinence model as well as in the harm reduction model (safer use). Both are valid goals.

Addiction is biological, psychological and spiritual in nature. In medicine, I deal with the biological and psychological to help with safe detox as well as with the physical craving and mental obsession for using drugs. I also help with relapse prevention. To my knowledge, N.A. focuses on a spiritual approach to help the physical craving and mental obsession for using drugs to decrease chances of relapse.

Together, a doc knowledgeable about addiction and its treatment and an N.A. member who is honest about his/her concerns and willing to participate in N.A. is an excellent partnership. I've seen that partnership produce amazing results. Making slow but steady progress toward a healthy fulfilling life is the way to keep your gains in recovery. Sometimes it's three steps forward and one step back, but in the long run the improvement is monumental.

As in all these threads, I welcome comments both in these threads. We all can teach each other.

Joel

Dr Pangloss
03-15-2009, 01:17 PM
There is a distinct separation from N.A. and medical management of addiction. To my knowledge as an Addiction Medicine doc, N.A. members are part of a spiritual fellowship in which they gather to support themselves in their personal recovery. Each member shares his own personal story of recovery. N.A. Members are not at the meetings to provide medical advice. Sometimes if medical advice is given by a non-professional this leads the N.A. member to stop medications that are actually helping them.

A doctor’s opinion differs from the N.A. opinion. It is important to note that few docs are actually trained in med school about substance abuse or its treatment. I've been in the addiction field for a while and have taught med students and other docs about substance abuse treatment. The information is getting out there, but it's a slow process.

Addiction is a disease and is chronic and relapsing, just like diabetes or cancer. Addiction is incurable, but is treatable. One can feel great and be healthy in every way in recovery. If you have an addiction concern, you can seek out physicians and therapists who have specialized or have a personal interest in this area. You will be treated with respect by these clinicians.

Doctors are trained to see a spectrum of an illness. I have an interest in both the abstinence model as well as in the harm reduction model (safer use). Both are valid goals.

Addiction is biological, psychological and spiritual in nature. In medicine, I deal with the biological and psychological to help with safe detox as well as with the physical craving and mental obsession for using drugs. I also help with relapse prevention. To my knowledge, N.A. focuses on a spiritual approach to help the physical craving and mental obsession for using drugs to decrease chances of relapse.

Together, a doc knowledgeable about addiction and its treatment and an N.A. member who is honest about his/her concerns and willing to participate in N.A. is an excellent partnership. I've seen that partnership produce amazing results. Making slow but steady progress toward a healthy fulfilling life is the way to keep your gains in recovery. Sometimes it's three steps forward and one step back, but in the long run the improvement is monumental.

As in all these threads, I welcome comments both in these threads. We all can teach each other.

Joel


It is a breath of fresh air to see a physician interested in a harm reduction model. My impression from the literature is that this is not a well-accepted model. That is, there seems to be a lot more literature on abstinence and 12-step efficacy than on harm reduction or "moderation."

Abstinence practitioners obviously view 'moderation' as a slippery slope, and often even appear to lump certain medications validly prescribed as part of that slippery slope.

Is there a growing interest in this model in the medical community?

Dr. Joel Nathan
03-15-2009, 04:02 PM
Yes, there is a growing group of health care professionals who are advocates of harm reduction. I will have a thread on this topic in the future.

Right now, all chemical dependency treatment is harm reduction in a way. Yes, most if not all programs in the U.S. use an abstinence model; however, how one defines success is changing. Patients are no longer kicked out of programs automatically for relapse. (This also may be due to financial considerations for the program too). Relapse is part of the disease.

So, when I have a patient who is still using drugs but is using less or in a safer manner, it's a win. I want my patients to get and stay as healthy as possible. Some do well with abstinence and others do well with harm reduction.

Two weeks ago, I had lunch with Dr. Andrew Tatarsky who has a psychology practice in Manhattan. He has written a book on the topic and lectures world wide. He is going to Poland shortly to start a harm reduction program for the country. Perhaps this would be a model for other countries as well.

Joel

Dr Pangloss
03-15-2009, 04:46 PM
i think this is a fantastic change. I had a friend die of a heroin overdose on a relapse. Had another that committed suicide. I'm just speaking from experience here, but it seemed to me that the severity of the relapses was exacerbated by the strict social consequences created in an abstinence environment.

you feel like such a failure you want to run yourself into the ground.


I wonder if "harm reduction" is what i'm seeing in "sober house" with dr drew. They are relapsing all over the place.

In my drug heyday, they threw you out for any violation, or sent you to a more severe and isolated program. For instance, "Impact" in Los Angeles...