11 of 14 people found the following review helpful:
1.0 out of 5 stars
What a misleading book!!!, August 12, 2010
This review is from: Addiction--What's Really Going On?: Inside a Heroin Treatment Program (Paperback)
I received this book hoping that it would be different from the few other books out there that discuss the oh so scary and frightening "junkies" in those down and dirty "inner city" methadone clinics and the "brave" people who work there, dishing out "tough love" and making snide remarks to their colleagues about "catching" patients in their "tricks".
Sadly, I was deeply disappointed.
As a Certified Methadone Advocate with a degree in professional nursing who does a great deal of educational work on a national level, and who sits on the Board of Directors of several national and local methadone organizations, I was APPALLED at the numerous myths, misconceptions and outright falsehoods throughout this book! I scarcely know where to begin.
Deborah McCloskey states that:
"Our clinic physician would start most people out at 40 to 60mgs, which should be enough to hold most addicts......In one of my sessions an old timer--a client--taught me about their world. She stated that any more than a 40 mg dose was just to get high, or they were still getting high. SInce the average dose was 80 mgs, I kept that fact in the back of my mind."
IN FACT, the average dose required to control symptoms in the majority of patients--and they are PATIENTS, not "clients"--is 80 to 120 mgs. Many patients require much more, due to tolerance, metabolism, certain diseases, etc. The dosing spectrum runs from about 20-30mgs all the way up to 1,000 mgs in rare cases. DUe to the phenomenon of tolerance, these patients are ALL tolerant of their dose and are not impaired in any way. Studies show that tolerant patients can drive, work, operate heavy machinery, etc with no cognitive impairment, regardless of dose.
Furthermore, allowing some patient to advise you of a myth they heard on the street somewhere (i.e., any patient over 40 mgs is trying to get high)and accepting it as a FACT is ludicrous. Patients hear and believe all kinds of myths--methadone turns your insides orange, methadone rots your bones, etc etc. It's up to the staff to counter those myths with the TRUTH--with science and fact--not accept them at face value, for Pete's sake! Patients who remain on low doses are usually the ones seeking to get high, because they know that doses over 80 mgs will block the euphoric effects of other opiates, so they keep their methadone dose below that amount so they can keep using. The fact that she, as a counselor in a clinic, is unaware of this is extremely disturbing.
She then says:
"The highest dose any of us had ever seen was 180 mgs. It was inconceivable how this client could function on this high of a dose. The 180mg client wanted to transfer from somewhere else to our clinic, but there was no way we could accommodate that dose morally, ethically or legally"
Again, this shows an appalling lack of knowledge of basic pharmacology, tolerance, metabolism of drugs, industry standards, or Best Practice guidelines.
Methadone was invented in the 1940's as a painkiller. The average dose given for pain is 5 to 10 mgs. One can clearly see that if we were to give a person with no opioid tolerance a dose of 30 or 40 mgs, they would be extremely sedated and quite possibly die. Such a person might think that if 5 to 10 mgs causes them to be pretty drowsy, then 30 to 40 mgs (the usual starting dose on the first day at a methadone clinic) must leave people unable to function! But of course, this is not the case--because these patients have a huge opioid tolerance.
By the same token, a patient who is stable on 100 mgs might imagine that someone on 200 mgs must SURELY be zonked out of their minds--because they know THEY would be. But again, because of individual tolerance and other factors, this is not true, and there is no way to tell the difference between a patient on 20 mgs and one on 300mgs by their cognitive abilities, demeanor, appearance, etc. The fact that she is unaware of this is, again, appalling and totally unprofessional. And she used this lack of knowledge and unprofessionalism to DENY a patient the right to move to a new city, because her clinic would not treat him.
Then she states:
"The concept of a dose increase as a solution (to withdrawal symptoms) never worked for me. I would do anything to prevent an increase simply due to the difficulty in eventual dose tapering. The fact that many of the clients were driving to and from the clinic and were out on the road, period, was my motivation."
Again, dozens of studies have been done, all showing the same thing--as long as the patient is not using other drugs and is stale on their dose, driving ability is NOT impaired in any way.
Stating that she would "do anything to prevent an increase" is flatly pathetic. These patients do not feel any kind of "high" or euphoria from their doses, and after a long time on the same dose, most patients will need a small increase to keep symptoms under control. McCloskey assumes that all patients will be getting off methadone so it's best to keep doses low. Not only is it false that tapering is easier from a "low" dose, but Best Practice Guidelines state clearly that patients should be encouraged to remain on MMT "for as long as they are receiving benefit from it". Patients who leave treatment relapse at a rate of 90% within one year.
Methadone treats a brain chemistry imbalance caused by a lack of natural opiates (endorphins). Sometimes this occurs naturally, leaving the person especially vulnerable to opioid abuse, and other times it is caused BY the opioid abuse itself. Sometimes it is temporary, but in many cases this is a permanent imbalance, causing the patient, when abstinent, to experience severe depression, anhedonia, exhaustion, anxiety and irritability. Most patients cannot long tolerate such ongoing misery, and relapse to opioid use.
Methadone restores the balance in the brain chemistry in the same way that insulin replaces the insulin no longer made by the diabetic pancreas. We do not encourage others who have chronic mental or physical diseases to cease taking the medication that is controlling the symptoms, because we know that if we do, the chances are enormous the disease will become active again. Yet, knowing this about methadone, McCloskey states that she does everything she can to avoid an increase, and elsewhere in the book she talks of her constant badgering of patients to get off methadone.She seems to view patients as dirty, smelly liars and cheats who must be closely watched lest they "get over" on her or try to "trick" her.
Overall, I was thoroughly disgusted by this book, and I am equally saened to read reviews that seem to think it's just great.
When I attended school to be an LCDC, our teacher warned us that there was a huge prejudice in the field against medication assisted treatment, and told us that we should do all we could to present a truthful perspective on this to our patients--but sadly, it seems the same old rumors, myths and nonsense are still out there.
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5 of 6 people found the following review helpful:
5.0 out of 5 stars
Learn The Real Story About Heroin Treatment Programs, August 13, 2009
This review is from: Addiction--What's Really Going On?: Inside a Heroin Treatment Program (Paperback)
Deborah McCloskey truly has a passion for working with heroin addicts, and that passion shows through in this book. Each story offers a heart-rending view of an addict and the people who care about them, the addiction and working to the other side, becoming drug free. McCloskey shows that while there is no easy fix, with understanding and care, and the proper medical treatment; all addicts have the means needed to change their life.
The characters are richly drawn, and you will find yourself rooting for them and caring about them. The actual discussion on the use of methodone and the psychology of addiction will prove useful to anyone with a loved one, friend, or family member in the grip of any addiction.
I would highly recommend this book for anyone who is considering pursuing a career in psychology, social work, or addiction counseling. You will find it invaluable. The book is written to appeal to the every day reader, too. You will learn from it, cry for the addicts, and cheer on the people in the trenchs working with addicts every day.
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4.0 out of 5 stars
Makes a big impression- Must Read, October 29, 2011
This review is from: Addiction--What's Really Going On?: Inside a Heroin Treatment Program (Paperback)
Description: (From book jacket)
"Addiction: What's Really Going On? contains powerful true-life stories woven together to form a tapestry filled with pain, joy, defeat, and success. The entire book is molded around Deborah McCloskey's heartfelt desire for her clients to be free of drugs. Her counseling methods both endeared her as "the counselor to get" and locked her into a decade of searching for better ways to help those she felt were stuck on the merry-go-round of a methadone system. This book should be read by teachers, hospitals employees, college students, government officials, and our general adult population whether addicted, sober, or straight."
Review:
Being a student of medicine, I was very anxious to read Addiction: What's Really Going On?, a book about life inside a heroin treatment program. This was a truly impressive read, both about the author's experiences with patients in the program and the addict's experiences. I had always known what I had heard on television and in books about addiction, but never had I been pushed into the reality of the addiction itself. So much emotion that it made me understand addiction almost like a disease instead of someone's mental inability to cope without the drug. I recommend this to anyone who has ever been curious about the topic and especially those who are dealing with their own, or a loved one's addiction; whether heroin or any other addictive substance.
Rating: On the Run (4.5/5)
*** I received this book from LibraryThing Member Giveaways in exchange for an honest and unbiased review.
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