Clinic Stories Possible Learning from Drug Addiction

Search for a theoretical framework that answers cultural, social and anthropological questions about man, using complements to live as a being-in-the-world, based on the psychoanalytic clinic. Investigate whether the use of narcotics is individual or a result of social issues that drive the subject to use psychoactive substances. Analyze the clinical structures linked to the use of these substances. To investigate the relationship between fractures with the law and chemical dependency, and religion/ spirituality, establishing links between clinical structures in drug addiction and society. As objectives: to investigate the issues with the Father’s Law and the use of chemical substances. Relate cultural and social systems linked to addictions; seek individual and family assumptions, perhaps social, that elucidate the necessary search for a complement/drug.

Mental Health and Chemical Dependency Services at US Cancer Centers

Background: It is standard of care and an accreditation requirement to screen for and address distress and psychosocial needs in patients with cancer. This study assessed the availability of mental health (MH) and chemical dependency (CD) services at US cancer centers. Methods: The 2017–2018 American Hospital Association (AHA) survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases were used to assess availability of services and associations with hospital-level and health services area (HSA)–level characteristics. Results: Of 1,144 cancer centers surveyed, 85.4% offered MH services and 45.5% offered CD services; only 44.1% provided both. Factors associated with increased adjusted odds of offering MH services were teaching status (odds ratio [OR], 1.76; 95% CI, 1.18–2.62), being a member of a hospital system (OR, 2.00; 95% CI, 1.31–3.07), and having more beds (OR, 1.04 per 10-bed increase; 95% CI, 1.02–1.05). Higher population estimate (OR, 0.98; 95% CI, 0.97–0.99), higher percentage uninsured (OR, 0.90; 95% CI, 0.86–0.95), and higher Mental Health Professional Shortage Area level in the HSA (OR, 0.99; 95% CI, 0.98–1.00) were associated with decreased odds of offering MH services. Government-run (OR, 2.85; 95% CI, 1.30–6.22) and nonprofit centers (OR, 3.48; 95% CI, 1.78–6.79) showed increased odds of offering CD services compared with for-profit centers. Those that were members of hospital systems (OR, 1.61; 95% CI, 1.14–2.29) and had more beds (OR, 1.02; 95% CI, 1.01–1.03) also showed increased odds of offering these services. A higher percentage of uninsured patients in the HSA (OR, 0.92; 95% CI, 0.88–0.97) was associated with decreased odds of offering CD services. Conclusions: Patients’ ability to pay, membership in a hospital system, and organization size may be drivers of decisions to co-locate services within cancer centers. Larger organizations may be better able to financially support offering these services despite poor reimbursement rates. Innovations in specialty payment models highlight opportunities to drive transformation in delivering MH and CD services for high-need patients with cancer.

Pain and Chemical Dependency

Pain can mean different things to different people. At the same time, it is a subjective and objective sensation. For the patient experiencing pain, it is an unpleasant sensation that causes undue suffering. Chemical dependency or addiction is characterized by inability to consistently abstain, impairment in behavioral control, and craving; diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and a dysfunctional emotional response. It is a complex chronic disease of brain reward, motivation, memory, and related circuitry. The prevailing view of opioid therapy for chronic pain is a pendulum swinging between opiophobia and opiophilia. The intersection between pain and addiction is also a moving target. Various stakeholders have attempted to find a balance between addressing the crisis of chronic pain in society and not exacerbating the problem of substance abuse. The pain practitioner must recognize the duality that exists between chronic and chemical dependency and must assess risk prior to using controlled substances to manage that pain, and if things go awry, the physician must have an exit strategy. Discharging problem patients merely transfers the problem elsewhere. Offering patients a solution to iatrogenic dependence on controlled substances is a viable and compassionate path for both the patient and the practitioner. This review contains 2 figures, 2 tables, and 20 references. Key Words: pain, opioids, opiophobia, opiophilia, substance abuse, chemical dependency, addiction, chronic pain