Subox.info

Treatment Facilities

If you know that you are a candidate for suboxone treatment, your best bet is to use the treatment-finder at Suboxone-Directory.com.  Many offices are at the 30-patient limit, so search outward from your local area.

If you are in Wisconsin, please check out my independent practice in Fond du Lac: The Wisconsin Opiate Management Center.  Visit me on the web at WisconsinOpiates.com.

What You Need To Know

As you investigate treatment options, there are several things that you will want to know about a treatment center that you are considering.  In order to prescribe suboxone, a practitioner must be able to provide or refer patients for counseling— an issue that physicians will often disagree on.  My own opinions on the matter have changed over time.  My early opinion was that suboxone would prevent use, but that the patient would  still have the character defects that are common to drug addicts, specifically dishonesty, lack of empathy, impulsivity, self-centeredness, and the inability to make genuine interpersonal connections.  I feared that patients on suboxone would be like ‘dry drunks’ discussed at AA meetings: people who don’t use, but who are so miserable that their family almost liked them better when they were drinking.

I have been surprised to see that in many cases, the defects that were so evident when the patient was using will disappear when the patient is on suboxone.  I now believe that in many cases, the situation is more dynamic.  Active obsession with using will take over the interests of the addict; the addict will also need to repress awareness of their current miserable condition, creating a ‘fake persona’ that comes across as superficial, cocky, and self centered.  But when the obsession is relieved, this situation will reverse.  With AA, we assume that the actual ‘recovery’ and elimination of addict traits will take a great deal of time.  This is to be expected in traditional recovery, as there is no quick elimination of the obsession with substances, but rather a long process of replacing the obsession with positive things.  The situation is different with suboxone, as the relief of the obsession is almost instantaneous.

The Need For Counseling

Back to counseling— Given the dynamic nature of the situation, I do not believe that counseling is necessary in all, or even in most cases.  I prefer to make the decision on a case by case basis, taking into account the length of active use, the patient’s unique psycho-social situation, the presence or absence of support, the presence of other mental illness, and the desires of the patient.  A patient who is forced into counseling is often wasting time and money.

As you look at programs, ask about the requirements or lack thereof for counseling and group therapy.  The cynic in me wonders if some programs use suboxone as a hook to fill their counseling appointments or evening groups.  If group therapy is required, what is the nature of the group?  I see little value in groups that throw addicts together with patients with other mental illnesses.  Who leads the groups?  Many addicts prefer groups led by people who have their own experiences with addiction, feeling that otherwise they will be judged negatively.  What happens if you miss a group, or want to leave a group?  Are you forced off of suboxone?  That, in my opinion, is wrong— sure, it may make the practitioner feel good about boundaries, but what does that do to the addict, to throw them back to the dangerous world of active using?

Other considerations

There are many other things to consider when looking at programs.  Will you be allowed to take enough to put your addiction into remission, or will you be forced to take a low dose (less than 8 mg) that will leave you craving?  Will you be forced off the drug at some point?  As opiate addiction is a life-long illness, many people will need life-long treatment.  Will you be able to get treated for depression, anxiety, and other psychiatric issues?  Please visit my blog, and feel free to post any questions that you have as you examine your options.

Check out these links:

DSM-V: The future of psychiatry and neuroscience

Breaking news in the field— new medications, new approaches— see it here first!

Warmal Globing: The other side of the global warming debate

A funny look at the debate over global warming.  Have a few minutes to kill?