Addiction Treatment

According to Dr. Fox, in the setting of substance abuse, abstinence of 18 month duration almost guantantees that a person will be protected from future relapses. Only 2 - 3% of people who can stay clean for 18 months or longer actually relapse. This is highly encouraging news. Another factor that helps promote abstinence is a supportive family environment. Halfway houses - uh uh - bad news. Most times there are drug dealers waiting outside to prey on the weak; social darwinism for you. The next best option, is a structured living environment such as the Q house here.

Motivational Interviewing

Today I did a presentation on motivational interviewing techniques for health behavior change. It went pretty well. Actually, very well. The attending, nurses, and resident here are so nice and supportive. So even if I presented gobbledigook, they would still think that I was awesome. That aside, motivational interviewing strategies to remember:

1. Ask pt about their typical day
2. Ask pt about causes and consequences of stress
3. Assess importance, confidence and readiness for health behavior change. Ask scaling questions like, "if 0 was not impt and 10 was very important, where would put yourself at?" Follow up with, why so high/low? If x, why not x-5? Stimulate motivational statements made by pt.
4. Do the Katz box to analyze pro/con of change/no change
5. Analyze previous successes and failures
6. Brainstorm solutions WITH the patient being the active decision maker.

Interview Tutorial

Today I had my tutorial with Dr. Fox. A word about Dr. Fox: he remembers your name. Everyone's name -- from the janitor cleaning up patient vomit to the chief resident whom he briefly met three months ago. He remembers people, places, daughter's graduations, etc. And its no wonder people love him. He connects, no matter who you are. Its awesome. That aside, I interviewed this guy who absolutely amazed me with his resilience. This guy went thru hell and back, twice over, I tell you. If you can imagine the worst of the worst, he has it, experienced it or did it. And yet he has forward thinking. He's intellectually brilliant and has found a place here where he can help out people who are far more physically and mentally debilitated than he is. He can find value in his existence and perservere. At one point in the interview he said to me, "I'm such a coward." And I was like, "I disagree. You've been through a lot and I admire your strength." I was genuine and I think he realized that I wasn't just saying fluffy nice things [and those who know me know that as I rule, I avoid fluffly statements of nothingness]. Patients hate that sort of thing.

Anyway, prison. Brutal. Our incarcertation system is the embodiment of pure evil. Very sick things happen in there and it breaks my heart to hear about it. As Dr. Fox put it, sometimes its hard to tell who should be on which side of the jail bars.

Psych ER

And thus ends my rotation in the Psych ER. I will miss it certainly. I love the fast pace of things, I like the quick plans, the immediacy of what you do and how much you get done. Its cool. Its real action. The most impt thing here is the Team. Yeah, people are always transitory and in flux, but we all work together and help each other out. My main man here is a fellow PA student; damn that guy dragged my ass thru this rotation by helping me figure out the computer system. That was the hardest part. He's the guy I packed a lunch for. We look out for each other. Yup, that's what team work is all about. Its been fun. Now onward ho!