by Mari McKee
An artcle explaining why willpower has nothing to do with addictions
|Addictions: A Matter of Willpower?
As a new nationally certified Physician’s Assistant, I accepted a position at a State In-Patient Substance Abuse Facility. I was responsible for performing histories and physical examinations on new patients, prescribing medications for drug or alcohol withdrawal, and for their medical care during their ninety day rehabilitation. Some came voluntarily and some were court-ordered for admission for treatment of their abused substances. I quickly learned that nearly all of my patients not only had a substance abuse problem, but, also, had an underlying mental disorder.
Addiction is a physical, as well as mental disease. It has nothing to do with will-power. Medical research has proven that there is a genetic component, as well as biochemical imbalances in both the body and the brain of addicts. It is not unusual to find pathological psychotic conditions that contribute to the patient’s addiction.
Most of the general public is ignorant, through lack of education, to the fact that addiction is often a manifestation of a deeper mental illness.
While I had the knowledge, I lacked the experience in treating individuals with addictions and psychosis.
One day, not long after I began practicing medicine, I had a new admission that I brought back to my office. I began my assessment as soon as I met this particular patient. The first thing I noticed was his rather strange appearance. He was wearing loose, flowing pants, a gauzy loose shirt, and plain brown sandals. He had long flowing hair and a full beard. His gaze was intent, and his few words were gently spoken with caution. Once in my office, I had him sit in a chair next to my desk where I sat facing him. I opened his new medical record and extracted his medical history form. After my very first question, I was sitting on the edge of my chair and intensely observing him. The first question was “Please state your full name, including your middle name if you have one.”
He gave me an honest and direct look and answered, “My name is Jesus Christ,”
I dropped my pen and asked, “Excuse me?” I just knew I did not hear him correctly.
He gently repeated, “My name is Jesus Christ.”
I must have had a look of bewilderment on my face because he held his hands straight out and said, “Behold!” In front of my disbelieving eyes, stigmata (a raised writing or drawing on the skin that appears spontaneously) of round, raised, red wounds appeared on the palms of both hands. I raised my eyes and we locked gazes. He then slipped off his sandals and pointed to the tops of his feet and said,”Behold”, and the same stigmata appeared on top of each foot. My mind was racing wildly, trying to make a differential diagnosis. He then raised his hands, each still bearing the stigmata and framed his face and again said, “Behold”, as a red raised drawing of a crown of thorns, complete with stigmata of drops of blood appeared on his forehead.
Trying to maintain my professional demeanor, I was systematically going through various psychotic illnesses but knew he was some type of schizophrenic because he was suffering from delusions of grandeur. I remember thinking that he could not be Jesus, because Jesus was nailed through the wrists, and not by the palms of his hands, which would not have supported his body weight.I guess I wanted to reassure myself that this was not the second coming of Jesus.
The patient was an alcoholic. He drank approximately 48 cans of beer daily. He was unable to maintain a job, so he preached and begged for money on street corners to get enough money to buy as many cans of beer possible. He had been arrested on several occasions for public drunkenness.
In order for him not to go into alcohol withdrawal, he was placed on a benzodiazepine, Serax, which is used for anxiety, acute alcohol withdrawal and produces an anti-seizure effect. It is given in progressive decreasing doses for approximately 5 days. Acute withdrawal can result in seizures. He was also given an anti-seizure medication, Dilantin, and placed in the Infirmary for observation for 48 hours.
Until he had no signs of acute alcohol withdrawal, I could not delve into his underlying mental illness. Delusions of grandeur are a symptom of schizophrenia. Stigmata are associated with religious delusions, such as his believing he was Jesus Christ. After testing him and talking with him for many hours, I determined he was a paranoid schizophrenic. He was put on a major tranquilizer,Haldol, daily to control his delusions and hallucinations, and another medication to help control the side effects of the Haldol. It took about two weeks for his schizophrenia to get under control. At this point, he could begin group and individual therapy and a 12 step program for alcoholism. He remained on Haldol and Cogentin and was seen by a psychiatrist twice weekly. Upon discharge,he was given a 30 day supply of his medications. He was placed in a half-way house and was given follow-up appointments for group therapy. He was to attend AA at least 5 days a week and was assigned a sponsor. He was also scheduled to see a psychiatrist for his schizophrenia.
He maintained sobriety until he ran out of his Haldol. He did not keep his appointment with the psychiatrist even though he had transportation from the half-way house. Within a week he was experiencing hallucinations. He also resumed his alcohol consumption which resulted in his being kicked out of the half-way house. He was back on the streets, preaching about God and begging for money for his beer.
Once again, he was arrested for public drunkenness and went through withdrawal symptoms while in jail awaiting a court date. The judge ordered him to return to addictions rehab. This is the typical vicious cycle for substance abusers with underlying mental disorders such as schizophrenia, depression, Post Traumatic Stress Disorder, Bipolar personality disorder and others. This time I referred him to a short-term inpatient psychiatric facility. Until his schizophrenia was being consistently treated, there was no use in treating his alcoholism.
One would think that if he would stay on his anti-psychotic medication, he would be able to control his alcoholism. One problem is that there must be follow-up outpatient visits with a psychiatrist for counseling and to obtain refills for the medications. However, there is a major problem in that many of the anti-psychotic medications can have terrible, debilitating side effects such as rigidity of the muscles, which can become a permanent disability. To help combat this side effect, another drug, Cogentin, must be given in addition to the anti-psychotic medication. Thus begins the vicious cycle with the patient being non-compliant with taking his medications. Then without the medications to control the mental illness, the addiction begins again. This explains why addictions are so difficult to treat.
The next time you pass a beggar on the streets, have understanding and compassion, realizing that he is probably an addict with an underlying mental illness living in a hell of his own. Do not judge others, or you, too will be judged. (Mathew 7:1)