Quitting more than one addiction

Published

I have very little experience with addiction and recovery, but a patient told me that he was told it is not realistic to try to quit both narcotics and ETOH at the same time. His practitioner placed him on meds for the narc withdrawal but told him drinking "in moderation" is OK as it is not realistic to expect to quit both at the same time. This sounds absolutely ridiculous to me. I've asked a couple of MD's that work our floor and they have also said it is poor advice. I'm baffled that anyone would recommend this to an addict. Maybe it is because the pt is doing this as an outpatient and not at an inpatient facility? Any thoughts?

Up Vote Up Vote ×

I've heard even worse. A very close relative was pregnant, and she smoked throughout the entire pregnancy because supposedly the Doctor told her that it would be worse for you to take away the nicotine from the baby. (Or some other bs reasoning) Sounded like a load of crap then, and what they said to you sounds that way too.

Up Vote Up Vote ×

I know in the 60's and 70's women were told to keep smoking during pregnancy for that reason. But, geez! Not now!

I just can't wrap my head around not quitting both.

Up Vote Up Vote ×

Wow, you're absolutely correct; this is incredibly poor advice. I have had considerable experience dealing with patients who are cross-addicted (alcohol and drugs), and I will sum it up thusly: Addiction is Addiction is Addiction. In other words, it doesn't matter what form it takes; you are altering your consciousness with a foreign chemical. If you try to separate them, you will not be successful in recovery; not to mention the fact that the meds for the narcotic addiction are most likely a narcotic or analogue (Methadone is the most common example) and should never be mixed with alcohol. Inpatient vs. outpatient recovery should ideally be based on circumstances; in reality it is usually driven by the type of health insurance (or lack of) that a patient has. You're in a tough spot; although your instincts are absolutely correct, you cannot ethically contradict the practicioner caring for this person. I know this doesn't change the circumstances, but I hope this helps to vindicate your instincts. Good luck, and never become so complacent that you stop questioning what doesn't seem right :)

Up Vote Up Vote ×
Specializes in Med Surg/ Rehabilitation.

I have a feeling that this person will just over compensate with alcohol now that he has been told that drinking is ok. What I mean is, since he is recovering from narcs, he will just drink more. AND, you should never mix meds with alcohol even if you're drinking in moderation. Geez. No, it's not ok if your an alcoholic!!!

Up Vote Up Vote ×
I have very little experience with addiction and recovery, but a patient told me that he was told it is not realistic to try to quit both narcotics and ETOH at the same time. His practitioner placed him on meds for the narc withdrawal but told him drinking "in moderation" is OK as it is not realistic to expect to quit both at the same time. This sounds absolutely ridiculous to me. I've asked a couple of MD's that work our floor and they have also said it is poor advice. I'm baffled that anyone would recommend this to an addict. Maybe it is because the pt is doing this as an outpatient and not at an inpatient facility? Any thoughts?

Real rehab centers help addicts get off of more than once class of drugs/alcohol ALL THE TIME :)...... His practitioner sounds like a fool and absolutely clueless .... Sounds like someone graduated bottom of the class :)

To get someone off of longterm alcohol and opiate use as an outpatient is horrendous (Amy Winehouse reportedly- from her family- was going off of ETOH cold turkey- how well did that work?). Alcohol withdrawal can absolutely be lethal. The side effects of opiate withdrawal can be lethal. The doc advising this would be crazy to do it outpatient.

Up Vote Up Vote ×

As it turns out, the person who recommended this is a COUNSELOR, not a MD, PA, NP or anyone with prescriptive authority. The pt was prescribed Subutex from a NP that was recommended by the Counselor. I wonder if the NP knows the whole story; I'd like to thing the Subutex wouldn't have been prescribed if the NP knew the pt was still drinking. The story just gets worse. The pt is long gone from our floor now but I really do worry for his safety and recovery.

Up Vote Up Vote ×
As it turns out, the person who recommended this is a COUNSELOR, not a MD, PA, NP or anyone with prescriptive authority. The pt was prescribed Subutex from a NP that was recommended by the Counselor. I wonder if the NP knows the whole story; I'd like to thing the Subutex wouldn't have been prescribed if the NP knew the pt was still drinking. The story just gets worse. The pt is long gone from our floor now but I really do worry for his safety and recovery.

IMHO, treating anyone for acute detox from anything is very risky. Complications don't give 24 hour warning :D. And if nothing else, a detox unit helps deal with the urges to run out and start using again- not all the time, but it helps. :)

Up Vote Up Vote ×
IMHO, treating anyone for acute detox from anything is very risky. Complications don't give 24 hour warning :D. And if nothing else, a detox unit helps deal with the urges to run out and start using again- not all the time, but it helps. :)

I totally agree! We have ETOH'ers frequently but we don't deal with the brunt of it. The thought terrifies me!

Up Vote Up Vote ×
Specializes in OB, Med/Surg, Ortho, ICU.

Though you've now found that the counselor recommended this route, I've heard the same story from those who are outright lying about what a professional says about their rehab because they dont want to hear the "quitting lecture" again from you. We don't detox someone unless we are treating a medical problem (usually pancreatitis), and I agree with previous posters- it is scary. The last one I took care scared the @$?! out of me.

Up Vote Up Vote ×
Specializes in CVICU, CCU, Heart Transplant.

This week we had a pt detoxing in the ICU after having a cath & stent placed. Pt ended up in 4-point restraints after trying to hit his wife, thrashing around, & sating in the low 80's on a bipap FIO2 100%. MD asked the wife to leave because it was unsafe for her in the room. We were giving him Ativan q 15 min with no success. We were getting ready to intubate him when I suggested, "...Maybe we could just give him a beer?"

Just reiterating that it can get pretty ugly. :D

Up Vote Up Vote ×
This week we had a pt detoxing in the ICU after having a cath & stent placed. Pt ended up in 4-point restraints after trying to hit his wife, thrashing around, & sating in the low 80's on a bipap FIO2 100%. MD asked the wife to leave because it was unsafe for her in the room. We were giving him Ativan q 15 min with no success. We were getting ready to intubate him when I suggested, "...Maybe we could just give him a beer?"

Just reiterating that it can get pretty ugly. :D

In a facility not cut out for detox, this can be the safest option...Our drivers at the detox/rehab facility were instructed to stop and get beers between the airport and facility (over an hour drive) to prevent detox symptoms on the road... More than one finished a 12 pack on the way, and were still shaky when they got there....

Up Vote Up Vote ×
+ Join the Discussion