I’ll Be Seeing You

June 23, 2012

in all the old familiar places…

In many different populations, but particularly in hospital or psych settings, there’s this person who we all know.  We’ve known him for years, and most of us are probably glad to see him when he returns to our groups: The frequent flier.

This past week, a man who I’ve known for years came back to the psych unit for the second time in two months.  He began our conversation by telling me how great it was to see me, and asked me if I had talked to a friend of mine who is his MT at another psych unit.  He attended my group, participated actively, socialized with the other patients and when it was finished, he told me how nice it was and that he was being discharged soon.  The little voice that lives in my head said silently, “See you next time!”  While my actual, therapist voice, said, “I’ll be back on Monday, so I’ll see you if you’re here.  If you’re not here, then take care of yourself!”  This mental conversation I had with myself is one that probably many of us have had regarding addicts in our psych settings.

I started my career as an optimistic, naive, happy-go-lucky gal who always saw the best in people and believed they could change. I am still optimistic, but after six years I am enveloped in reality about the actualities of the world in which I work.  There ARE people who improve.  There are people who were admitted to the unit who I have never seen again, and probably just needed a med adjustment or a wake-up call.  There are people who have had a breakdown, but then are fine and go back to their real lives stronger and better equipped to take care of themselves, but they are few and far between.

Then there are patients who have moments of clarity, usually about an addiction, and say things like, “I’m being discharged tomorrow!  I hope the next time I see you, it’s in the supermarket.”  and I wish them luck. I used to be so hopeful for those people, but then they would come back.  Time. After. Time. After. Time. After. Time.  On the fifth time I’d see them, I would still say the same things, but I stopped believing them, and I would feel like I’d been had.  Most patients who come to my unit have been there at least once before.

I’m brought back to an old episode of Scrubs.  Elliot (Sarah Chalke’s character) was dealing with a patient who had pain that didn’t seem to be coming from anywhere.  The patient refused meds but would scream in agony so badly that Elliot insisted upon pain medication and wrote a prescription against the advice of cynical Dr. Cox, who believed the patient was feigning pain (very well) to receive pain meds.  Elliot, a new intern, completely fell for the charade (which was eventually clear) and Dr. Cox explained that experience can make you jaded, but it can also help you to see unhealthy behavior in people, when an outsider doesn’t see anything questionable.  That same med-seeking character appears later in the series as an addiction counselor who has supposedly gotten clean, but we find out during the episode that that is yet another charade, and that he is  still using.

I’m aware that Scrubs was a television show and that that story wasn’t true, but I also know that I have met that type of person before.

Every time one of my frequent fliers comes in, they tell me that they’re really serious this time.  They’re definitely not going to go back to their old ways.  They’re going to get rid of their user friends and join NA or AA, or move to the Salvation Army and change their lives for good.  They really mean it.  And then they come back.

The problem, however, is not with the patients.  Addicts are in a bad place and need more than a few days of detox and reflection, but most units, at least in my area, are short-term, so where is the actual help coming from?  When I was in internship, we worked in a 28-day addiction program once a week.  In the six months I was working there, I only saw one person (out of hundreds)  have more than one admission.  I realize this doesn’t mean that everyone went home and got clean and sober, but I have more hope for programs like that where the patients have intense therapy day in and day out and have more than a week to straighten out their addiction, and their thoughts and priorities.  Why aren’t there more 28-day programs?  Why isn’t there longer-term care for addicts?  The more I wrap my brain around the amount of money we must spend on short-term addiction care, the more I think it’s a waste.  We are setting fragile addiction patients up to fail with the system we are using, and we are not giving them the tools they need to be successful upon their discharge.  We are almost ensuring that they will return to the unit at some point because they are not prepared for their own independence, and don’t know how to navigate their own lives without addiction.

Until something changes in our health care system regarding how we care for addicts, my guess is that we’ll keep seeing them, time and time again, and treating their addictions in vain.


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