Tag Archives: Treatment

 

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I recently had the honor of receiving the 100th review for Addiction on Trial on Amazon.  I am truly honored and appreciative to all who have left such remarkable and heartfelt reviews of my book.

I wrote Addiction on Trial with the goal to entertain as well as educate, and I immensely enjoy hearing feedback about the impact the book is having.  This blog is simply a special thanks to all the reviewers and to take the opportunity to share a few reviews that represent a theme. These types of comments have further inspired me to  finish the sequel to Addiction On Trial and I will continue to work diligently to make Lost To Addiction as enjoyable and as educational as it's predecessor.

Most importantly, I am pleased that Addiction On Trial is appealing to such a diverse group: lovers of mysteries and legal thrillers; followers of Crighton, Cook and Grisham; addiction professionals; folks concerned about how to educate high school students or personally touched by addiction; and page turning fanatics 🙂  A SPECIAL THANKS TO ALL !!!

This Book Reads Like a Screenplay..and I Can't Wait to See the Movie!

The timing of the publication of Dr. Kassel's book could not have happened at a better time. Since Philip Seymour Hoffman death, there's been a lot of long over due attention to the topic of addiction. Dr. Kassels' book is a gripping tale that graphically illustrates what the disease of addiction brings to a family, and how from there it trickles throughout the community at large. It is in all of our lives, on one level or another. His book reads like a screen play and it wouldn't surprise me if it is made into a movie one day. Plus, there's bound to be a sequel which I can't wait to read it as well.

Riveting Stuff

Once you pick up this book, you find yourself moving faster and faster to the dramatic conclusion. Its an absolute page turner and the courtroom drama was smart and believable! A story that keeps you guessing to the end but more importantly a raw and compelling insight into the complexity and desperation of addiction. I confess to a slight addiction to John Grisham. This was every bit as good. And the fact that Kassels is a guru on addiction gave the book a feel of substance and gave me a base of knowledge that I did not have before. It truly was interesting and enlightening. Cant wait for the next one!

Nuanced Medical Thriller

"Addiction on Trial" is a serious medico-legal mystery and page-turner. If you're a fan of the big names in this field like Crighton, Cook, Grisham, etc, then give Kassels a try as well. My usual complaint with the genre of "medical thrillers" is that the "medical" side of the story is usually grandiose and non-believable. Not so with "Addiction on Trial". Dr. Kassels has weaved a medical storyline that is nuanced, entertaining, factually accurate, and keeps you guessing until the very end. Well done! I'm looking forward to the sequel already!

Don't Miss Out On This Book

WOW, I could not put this book down. Every chapter got better and better. It was loaded with suspenseful moments just when I least expected it. I felt myself getting wrapped up in all of the characters lives and gaining a greater understanding around the challenges of addiction. Kassels is a master of valuable information and experience along with a creative powerful writing talent. Absolutely a dynamite combination. I look forward to the sequel with great anticipation. I wonder what Shawn Marks will get into next?

Page Turner Extraordinaire

I could not put it down, and stayed up till 3AM to finish it. Besides being very entertained, I learned much about an unfamiliar realm.

The book casts a new and sympathetic light on a problem we tend to relegate to unfair stereotypes.

So Insightful!

Dr. Kassels weaves a captivating mystery thriller that takes the reader into the entangled world of drug addicts. He not only skillfully shows the emotional havoc drug addiction creates for the individual, his or her family, and the community at large, but also explains the medical and legal implications of the disease. I think young people would greatly benefit from reading this book and suggest that it be required reading for high school health classes.

Dr. Kassels hits a first serve ace...

Addiction on Trial was a great read and I breezed right through the book. The story line, the characters, their interactions and the author's descriptions throughout kept me engaged. I came away with a better understanding of what doctors and nurses go through in emergency room settings, and the helpless feeling many families have when dealing with addiction issues. The timing of the release comes when coverage of heroin overdoses has taken off. Over prescribed, expensive pain killers morphing into heroin have become a challenge to treatment and rehabilitation. This book gives an accurate account of the perils of addiction and how it affects many lives. By bringing awareness to addiction, Dr. Kassels is shedding light on the problem without being preachy or judgmental. His book is a great vehicle for opening discussions about a topic that is obviously wreaking havoc on all walks of life.

Fantastic, smart, captivating, frustrating and so satisfying!

Fantastic read! Where do I begin? A close loved one was/is affected by addiction, so years ago I started reading blogs by opiate addicts--both active in their addictions and in recovery. I was trying to understand more about the experience of addiction itself and the recovery insights that survivors could share. I learned that addiction IS a disease, harm reduction helps keep more people alive to have a chance at recovery, and maintenance treatment is an important, valid, effective and "respectable" path to being a functional, happy, healthy person. I eventually stopped reading the blogs, but I am still fascinated by the topic.

Imagine my excitement when I found that an expert in addiction treatment wrote a novel about this! Addiction on Trial gives a deeper look into the larger world around an addict: family, relationships, medical treatment and the legal system. It's a fascinating thriller--and so frustrating (and real!) to see how addicts can be their own worst enemies, by trying to do what's "right" for themselves and other addicts. It's heartbreaking to see how a community will judge addicts, when it's a harder experience than any of us can imagine.

The characters are also so fascinating! Each one has their own motive, and they work perfectly together to form one cohesive mission. More like two sides at war, actually. If you have any interest in addiction, or you just enjoy legal or medical thrillers, this is a great read.

Riveting and Educational! Fantastic Read!

As a licensed addiction treatment professional I am always looking for information that can help educate the public about the issues of addiction and recovery. This book is the ideal balance of providing basic education on addiction side by side with understanding the human side. Dr. Kassels does this exceptionally well by blending them in a way that keeps the reader engaged and informed at the same time. This is a must read that should be in the arsenal of all treatment professionals!

I loved every aspect of this book and really it should …

Rarely would I give a book five stars and I have been meaning to review this book for months, I loved every aspect of this book and really it should be characterized as Literary Fiction because not only was I engaged and entertained, I was thoroughly educated as well. I heard the author today on NPR and his passion and his dedication reminded me that I needed to write this review. Without question it is a five star winner.

 

 

 

Author : skassels [hupso]

Welcome back to Ten Reasons for the Heroin Epidemic. This is the second and final primer to lay the foundation before launching into the ten reasons we currently have a heroin epidemic raging across our country.  But before I proceed, I hope you all will read the recent article published in the New York Times on April 17, 2015 entitled, Serving All Your Heroin Needs. Here are two quotes that are extremely revealing:

heroin1

“… selling heroin across the United States resembles pizza delivery.”

“… a new home for heroin is in rural and suburban Middle America …”

To better understand why pizza delivery of heroin works and how it found its way into suburban and rural America, there are three related terms that are essential to understand:

  • Tolerance
  • Dependency
  • Addiction

Tolerance refers to not getting as much bang for the buck.  In medical terms, it is the body’s adapting to a drug which then necessitates consuming more of the drug to achieve the same effect.

Dependency refers to the state of having symptoms in the absence of the drug. Examples of withdrawal symptoms are the “shakes” after a heavy drinker stops drinking; or the chills, nausea, vomiting, abdominal cramping, etc. when a heroin addict is deprived of his/her next “fix”.

heroin2

Addiction is the drug seeking behavior of an individual.  However, a person who is dependent may not necessarily be addicted.  Remembering from the last blog that the disease of addiction has bio-psycho-social aspects, a person may become dependent but not have the components of addiction.

For example, if sweet Aunt Tillie ends up in the hospital with severe intractable pain from a tumor pressing on her spinal column, she may be given an opiate such as morphine to reduce her pain until the tumor size can be minimized by radiation or chemotherapy or surgically removed.  A few weeks of medication may be needed and during that time Aunt Tillie develops tolerance and dependency to morphine.  After the tumor size is reduced and the pressure on the spinal nerves is diminished, the frequency and amount of morphine is gradually decreased to avoid withdrawal symptoms. After a week or so, Aunt Tillie will no longer require an opiate to eliminate her pain and will be showing no signs of withdrawal. After she is discharged home, she is happy taking an occasional non-narcotic pain medication like Tylenol or Ibuprofen. But how about the person who goes home and has some bio, psycho and/or social components of the disease of addiction. He/she may very well start looking for that euphoric “high” and start seeking drugs.  That is the essential difference between dependency and addiction!

We are now ready to delve into the 10 reasons we have a heroin epidemic. Next blog we will focus on the injudicious prescribing of opiates by doctors as reason #1. But first let’s get a look at Jimmy, Annette and Travis – they are dependent and also addicted.

Annette laid out several lines of cocaine, one definitively larger than the other two. Everyone knew the “fat line,” as they jokingly called it, was hers. Travis prepared the portions of heroin, which had already been processed to a fine powder for snorting. They were now ready to snort their speedballs, a combination of heroin and cocaine. Annette much preferred an amphetamine rush, so her drug cocktail was heavily weighted with the cocaine powder and contained only a small amount of heroin. The reverse was true for the boys….

Within an hour after the speedball, Annette craved more cocaine, but she wanted to set an example for Travis, who undoubtedly would soon be itching for more heroin. Her cocaine buzz was starting to dissipate and numbing herself with alcohol served as a distraction to the hollow depressed feeling as a result of the depleted levels of the chemical dopamine in her brain. Dopamine, a neurotransmitter, is an essential naturally occurring compound that is required to stimulate the portion of the brain that elicits the feeling of pleasure. The greater the frequency and amount of cocaine used, the greater the amount of dopamine is depleted. This results in longer lag times for the brain to produce sufficient quantities of dopamine and therefore progressively longer periods of pleasure deprivation and sadness. This vicious cycle encourages more use, which only partially rectifies the effects of the depleted dopamine stores. Annette did not need a course in neurochemistry to understand that doing more and more lines was a never-ending journey.

 

Author : skassels [hupso]

September is National Recovery month, which is now in its 25th year!  "National Recovery Month is a national observance that educates Americans on the fact that addiction treatment and mental health services can enable those with a mental and/or substance use disorder to live a healthy and rewarding life. The observance’s main focus is to laud the gains made by those in recovery from these conditions, just as we would those who are managing other health conditions such as hypertension, diabetes, asthma, and heart disease.”

Recovery Month spreads the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover.  This year’s theme, ‘Join the Voices for Recovery: Speak Up, Reach Out,’ encourages people to openly speak up about mental and substance use disorders and the reality of recovery, and promotes ways individuals can use to recognize behavioral health issues and reach out for help.”

So this month, I wish to again focus my blog on further destigmatizing and demystifying the disease of addiction. This illness has no socio-economic barriers and two recent articles definitely reinforce this.  It is time to abandon any and all preconceived stereotypical notions we might have!  Give it up!  We are all affected, regardless of skin color, race, religion, education or employment status.

Please check out these two articles and be sure to let me know what you think!  Vermont Quits War on Drugs and Whites Account for Rise in Heroin Deaths

I hope you will consider reading my book “Addiction on Trial” and remember that its subtitle could just as easily read “Tragedy Anywhere USA”.  Please also consider checking out a previous blog: We Need More Doctors Like Saul Tolson to better understand the biological, psychological and sociological components of addiction.  And just imagine what it must be like to be the parent who gets a call that your son is A Heroin Addict in Jail

September is Recovery Month – Spread the word!!!

Author : skassels [hupso]

"The Scourge of Heroin Addiction"  

Op-ed published by the Boston Globe April 1, 2014  http://b.globe.com/1kAzt54

Governor Deval Patrick has appropriately declared the opioid addiction epidemic as a public health emergency.  The governor's directives will save lives and help to put some brakes on this run away scourge to society.  But questions remain and more issues need to be  addressed. 

For example, why is medication management for the treatment of heroin/opioid addiction scorned by so many? In a recent Boston Globe article, "Heroin Epidemic Exposes Deficiencies In Care System" (http://b.globe.com/1iNFmzo), Ms. Jacobs, Director of Substance Abuse Services for the Commonwealth of Massachusetts, acknowledged, "medications are not used as much as they could be for opiate addictions because of stigmas attached to them, she said."  We watch endless commercials about how to treat illnesses such as urinary incontinence or erectile dysfunction but public service announcements addressing the heroin/opioid epidemic and the proven benefits of outpatient cost effective medication management have been relatively sparse.  The governor's directives, which include public health advisories to educate the public about opioid addiction treatment options, will hopefully demystify common misperceptions, such as crime increases when there is a treatment center in one's community. In fact, there is a 50% to 80% reduction in crime by heroin addicts when in treatment. (http://bit.ly/OVVRfh ;  http://1.usa.gov/1dtb42B)

We read about the blame for the heroin epidemic, but rarely do we address a complex underlying issue – that we as Americans want instant results and we want total pain relief after an injury or procedure.  Injudicious prescribing of pain medications undeniably contributes to the problem, and holding doctors accountable is essential; but this is not the only reason we have an unabated heroin epidemic. Other factors include: the war in Afghanistan, which directly led to a surge in heroin production; the reconstitution of oxycontin pills, so they could not as easily be used to "shoot up" or "snort", resulting in more persons turning to heroin as a drug of choice; the increased availability of opiates through the internet; inadequate mental health treatment services resulting in some patients "self-medicating"; and the lack of addiction treatment facilities due to a common community approach of NIMBY (Not In My Back Yard) along with the stigma associated with seeking treatment for the disease of addiction.  Despite the arrest of kingpins and drug pushers, big and small, we still have a supply and demand problem. The supply of heroin has increased and cost is down to as little as $4/bag. As fast as we take drug pushers off the streets, they are replaced by others - there is too much money involved.  Governor Patrick is right to focus on the demand side of the issue.

If outpatient treatment is not more widely accepted and available, inappropriate hospitalizations and incarcerations of patients will continue.  It is time for our locally elected officials to openly support establishing treatment centers in their communities?  We all know heroin addicts, albeit we may not know who they are. They could be any one of a number of patients I have treated: your plumber; the mailman; your kid's college professor; the IRS agent who audited your tax return; the person selling flowers at the corner; the principal of an elementary school (http://bit.ly/1m6XMbL); someone who works in a mayor's office (http://bo.st/1hbtN20); or a neighbor; or a family member.

A recent study has shown that less than 20% of individuals needing addiction treatment actually received treatment (http://1.usa.gov/1hYRzvX)..  Another study found that only 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment and that "most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat the disease, and most of those providing addiction care are not medical professionals and are not equipped with the knowledge" (http://bit.ly/1o2l3Ax). Are we willing to accept as status quo the present system of  unnecessarily hospitalizing or incarcerating patients?  We are wasting tax dollars: it costs up to $50,000 or more per year to incarcerate (http://bit.ly/1iBKSlg ; http://nyti.ms/NW5dGQ) and approximately $5,000 per year for outpatient treatment (http://bit.ly/1rCh3G6). “There are things besides beds that are effective in this system,” Jacobs said. “More people should see this treatment as a viable option.”  (http://b.globe.com/1iNFmzo)

There should be just as many public service announcements about addiction as there are Viagra and Cialis commercials. In addition, expansion of addiction treatment services in jails would help to mitigate much of the revolving door phenomenon. Furthermore, we should demand that our medical schools and hospitals improve addiction training of our physicians. While there is plenty of blame to go around, let's focus on the solutions. The scourge of addiction is in all of our yards.  The solution is to decrease the demand with bold public initiatives and a change in attitude.  It is both the humanitarian and fiscally responsible thing to do.

Steven Kassels, MD has been Board Certified in Addiction Medicine and Emergency Medicine.  He currently serves as Medical Director of Community Substance Abuse Centers and has authored the book, “Addiction on Trial: Tragedy in Downeast Maine”.  

Author : skassels [hupso]

I hope you enjoy meeting Dr. Saul Tolson.  At the time of this therapeutic session, Jimmy had been "clean" from heroin for thirty-four months.  This would be one of his final sessions with Dr. Tolson before moving from Kansas City to Downeast Maine, where Jimmy would be accused of murder.  Read on and experience the life of an addict, who struggles with his past demons; and meet Saul Tolson, the compassionate and insightful therapist, and listen to one of his passionate lectures on the disease of addiction.

Addiction on Trial: Tragedy in Downeast Maine; Chapter 13.

It was the end of March when Jimmy finalized his plans to return to West Haven Harbor. His last three sessions with his Kansas City therapist, Dr. Saul Tolson, were dedicated entirely to the courageous steps and the inherent risks of changing his habitat and job. They reviewed the triggers to drug use and the need for continued awareness that drug addiction is a chronic disease, a lifelong challenge.

Jimmy had heard all of this before but no longer exhibited a defensive response to the message. He was full of optimism. After more than twenty years of drug abuse and addiction, three years at an alternative high school focused on building self-esteem, multiple rehab experiences, and a near death experience, he felt he finally understood the pressures and cues that had guided, or misguided, him all these years. Jimmy had finally acknowledged and fully embraced the message that he could not blame his actions, his addiction, on others. He, and only he, must be accountable for his behavior. He acknowledged and accepted the Twelve Steps of Narcotics Anonymous, a self-help program modeled after Alcoholics Anonymous.  Although he could not relate to what he considered to be the subliminal religious connotations of NA or AA, he did ascribe to the message that he needed to admit that which he had no control over and do his best to stay abstinent from drugs and alcohol.

As a member of a program of rigorous honesty, it was problematic to conceal that he was taking a prescribed replacement medication like methadone. He was not alone, as other participants withheld information about medications prescribed by their doctors to treat symptoms and manifestations of illnesses related to the disease of addiction. Many individuals become addicted after turning to either illicit drugs and/or illegally obtained prescription medications in an attempt to self-medicate a primary brain disorder such as depression, anxiety, or bipolar disease. The diagnosis of underlying mental illness can be more difficult to determine for those with the disease of addiction, but many participants in NA and AA do benefit from prescribed medications, some of which have value in the detoxification from drugs and alcohol. Even though many NA and AA groups discourage the use of some prescribed medications that may have effects on the mind, believing that a medication-free approach is always best, most physicians and many Twelve-Step followers disagree with this philosophy.

Jimmy learned through NA and counseling that he could no longer use as excuses the pressure he felt from his father’s professional success or the abandonment by his mother due to her premature and tragic death when he was barely three years old. It had taken him over thirty years to be able to talk about the “what ifs.” What if his mother, had lived? What if she had not left the house that evening to check on an elderly neighbor when the electricity failed? Why couldn’t her friend, Marjorie, have gone instead? These were questions he would never be able to answer, but he was finally able to forgive her and to stop blaming himself for her death. He finally felt at peace with his mother and thought about her daily. He kept her picture in his wallet. He was no longer angry; sadness replaced that destructive emotion. How could he be angry with his mother; she had been so thoughtful and caring in her actions that evening. He was so proud of her and whenever he looked at her photo he could feel her warm eyes looking back at him. He desperately wanted her to be proud of him.

“Jimmy, are you okay?” inquired Dr. Tolson in one of their last sessions.

“Ahh, yes, I was just thinking.”

“I knew that, but what about? It must have been important. You were scratching again at your hand.”

“Yes, I know. When you asked me if I had fully given up my anger and was ready for this transition, I started thinking again about my mother. I really am not angry anymore, but I’ll always wish I could have gotten to know her better. It still hurts that I have no real memory of her when she was alive.”

Dr. Tolson, whom Jimmy called Saul, let silence rule the moment. In his mid-sixties, about the age of Jimmy’s dad, his wiry body was clothed in blue jeans and cowboy boots. He had planned to retire after giving up his private practice of psychotherapy five years earlier and saying good-bye to his many neurotic middle-aged clients. But after two years of retirement he became restless and took his PhD in Psychology into a different arena, first as a part-time consultant and then as a full-time drug counselor at NewBeginningsAddictionCenter. He had never enjoyed work more. The fact that he could trade in his sport coat and tie for more relaxed attire was not an insignificant aspect to the enjoyment he felt while working in his retirement years. Seasoned, articulate, insightful, and with a professional demeanor and attitude of refined independence, he had mentored many young therapists throughout his professional life, and more recently at New Beginnings. But his greatest contribution was to his own patients. He preferred the word “patient” to “client.” This was not a practice of suburban psychotherapy; this was the psychotherapeutic arm for the treatment of a chronic disease and Jimmy was a patient.

Dr. Tolson understood in a very philosophical manner that Jimmy’s illness, the disease of addiction, was composed of biological, psychological, and social elements. He would give lectures on a regular basis to fellow drug counselors, local school committees, police, and to anyone who would listen. He always started his presentation the same way, with a story about the Harvard crew team.

“When I was at Harvard, more years ago than I wish to remember, I was initially confused about why the crew coach recruited athletes who had no prior rowing experience to try out for the scull team. The coach preferred to train disillusioned or frustrated former football players or other passionate athletes who were not quite talented enough to play their chosen sport at the college level. He wanted to teach these athletes how to row from scratch and to learn his way. He was of the philosophy that it is more difficult to undo a wrong technique than to teach the unindoctrinated the correct method. This strategy seemed to work as the Harvard scull teams were always competitive, even at the Olympic level.”

He continued his presentation with a comparison between the approach of the Harvard crew coach and his own current predicament.

“Well, I do not have the luxury of the Harvard crew coach. Everyone in this room already has an opinion of what an addict is. Usually we use the word addict in a special way—cocaine addict, heroin addict, but rarely do we hear the words alcohol addict or nicotine addict. No one would refer to Vice President Cheney as an addict, despite the fact that we know that nicotine contributes to heart disease. And Mickey Mantle remains a hero despite needing a liver transplant because of liver cancer, complicated by cirrhosis from his years of drinking. I am hopeful that each of you can put aside any bias, any preconceived notions that you bring here today. For thirty minutes I ask that you be like that athlete who has never rowed before and put aside your current opinion of addiction. Give me your cleansed minds for just a brief time. At the end of my presentation you may accept, reject, or modify anything I say, but please start now with a clean slate. Before I begin, I want everyone to join me and tightly close your eyes. For just sixty seconds let us each listen to our own breathing and contemplate nothing.”

Not everyone followed Dr. Tolson’s request, some dumping him into the category of one of those earthy crunchy granola type liberals—precisely the type of labeling he was trying to combat, which is why he would wear a sport coat and tie to the lectures. He would wait a full sixty seconds before saying “Now, slowly open your eyes and without verbally responding, I want you each to ask yourself if the last sixty seconds were spent only listening to your breathing while repressing all thoughts. If you were not successful in completely voiding your mind, you now know the struggles of addiction. It is not just mind over matter. I will do my best to further explain the complexities of addiction.”

Dr. Tolson had a sincere and disarming manner to his presentation. Part professor, part psychotherapist, part scientist, but always human, he discussed in painstaking detail the disease of addiction in a respectful manner while laying out the cornerstones of the disease as a bio-psycho-social illness of lifetime duration. He described it as a disease of incurable nature, possible to be put into remission, similar to some cancers. He elucidated the Scandinavian alcohol studies of identical twins being adopted by different families to illustrate that genetic predisposition as well as Skinner-like conditioning were contributing factors. He explained how veterans who had become heroin-addicted in Vietnam could more easily overcome their drug use when returning stateside as representative of the social aspect of the disease; that the elimination of social cues was such a powerful determinant of remission. But the next eye-opening part of his lecture was the presentation of slides showing the reward centers of the brain. He only spent about two minutes on these projections, but it was compelling information.

“I now wish to briefly bring your attention to these next few slides. Here is the nucleus acumbens, the ventral tegmental area, and the prefrontal cortex. They all are integrated into the activation of the brain’s reward pathway.”

Saul Tolson knew all this scientific mumbo jumbo lulled much of the audience to sleep, but he needed everyone to be alert for his next comment. He purposefully lowered the octaves and raised the volume of his voice while adding brief pauses to summon attention as he continued.

“Now, for those of you who have dozed off . . . and I do understand why . . . this next slide is a must to see. It clearly demonstrates that there is very little disparity between the different chemical addictions. This colorful slide demarcates the areas of the brain affected by various drugs and clearly illustrates that alcohol, nicotine, cocaine, and heroin all create their effects through the same common pathway, which originates directly or indirectly at the level of the nucleus acumbens. In fact, the same medication, called naltrexone, is used to curb the craving effects of both alcohol and heroin.”

Dr. Tolson concluded his medical presentation with a sobering analogy.

“Diabetes is a chronic disease. It is a disease that can be controlled, but, as of yet, cannot be cured. It has a genetic component but is exacerbated by poor diet, lack of exercise, and lack of attention to medical management. Think about a person with uncontrolled diabetes or for that matter a smoker with heart disease who eats a bag of potato chips on Super Bowl Sunday and goes into congestive heart failure. Both of these patients now need emergency care that doctors immediately render. Many of these patients return again and again, and for many it is for reasons at least partially due to their noncompliance with recommended treatment. Nevertheless they are readily evaluated and treated for both their acute and ongoing illnesses, even though their own behaviors are contributing or causative factors to their deteriorating health.”

Pausing while attempting to make eye contact with each and every individual in the audience before proceeding, Dr. Tolson delivered his next few lines in a compassionate tone. “With no disrespect, but as a way to reinforce the point I am trying to make, I’d like to ask you to please tell me the difference between a nicotine or alcohol addict, who in some cases may even receive a heart or liver transplant, and someone addicted to heroin or cocaine? Why are those afflicted with the disease of addiction to certain drugs treated so differently than patients who suffer from nicotine or alcohol addiction or other chronic diseases like diabetes? Are they really any different?”

Dr. Tolson never relinquished the podium without one last attempt to convert the naysayers. “Now for those of you who fail to agree with me, and I know you’re out there, let me appeal to your wallets. To incarcerate one addicted patient—that’s right, jailing patients—costs between $40,000 and $50,000 per year. A one-year stay for a patient in a halfway house costs society about $20,000 per year and this does not include any medical care. But to treat one heroin addict as an outpatient with regular individual and/or group counseling sessions, ongoing urine drug testing to monitor for illicit drug use, a complete admission physical exam including laboratory tests that screen for contagious diseases such as Hepatitis C and HIV, and the daily monitoring of medication administration costs approximately $5,000 per year! That’s right—only $5,000 per year or about one-tenth the cost of putting this patient in jail! And how much does it cost and what is the risk to society when patients are denied access to care and get sick with HIV and spread that disease? So what’s the total economic cost of drug abuse to society? You better be sitting down, because according to a ten-year study from 1992 to 2002 on the economic costs of drug abuse by the Executive Office of the President for National Drug Control Policy, the financial price tag to society related to crime, health care, and lost worker productivity is 182 billion dollars—yes, you heard me correctly—182 BILLION dollars! Is not an ounce of prevention worth a pound of cure? Like they say in the Midas commercial, ‘you can pay now or you can pay later, but you’re gonna pay.’ Thank you all for your attention. I am able to stay for questions.”

Uncomfortable with the inevitable applause, Dr. Tolson kept repeating through the clapping, “So, there must be some questions.” The questions came, but none of his answers carried the consequences of those he would have to give to questions posed while under oath at the murder trial of James Frederick Sedgwick in Downeast Maine.

Author : skassels [hupso]