The Cab Driver Story: Single Session Psychotherapy

Another story came out of the APA conference that Dinah wanted me to blog about.

I was in a cab going to pick up Dinah for dinner. The cab driver found out I was a psychiatrist so he told me about his life-changing experience with therapy. At one time he was having an incredible problem with his life. He was using cocaine, couldn't keep a job and his relationships were going down the tubes. Therapy helped him quit cocaine and change all that. (Which was good, since he was the driver of my cab. I really wanted him not to be high or in distress.) This kind of turn-around story isn't unusual for me; parolees will often come back and tell me about things they've done in free society that they're proud of.

The unusual part of this story is the fact that he made all of these changes after a single one hour session.

OK, that got my attention. What was it about this therapist?? What happened in the session?? I had to ask all the questions.

The cab driver told me that it wasn't so much what the therapist said, but rather who she was. She was a kindly, older woman who was sincere and compassionate. She told him he needed to start taking care of himself, eat better, get enough sleep, etc etc.

And that worked. Geez, I was impressed. It changed his life. The last remaining habit he wanted to fix was his smoking. He wanted to go back and see his therapist again, but she had retired. He was sorry he couldn't go back, and so was I.

That's my cab driver story.

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Wait, says Dinah (who added the pic and subtitle): you told it in a more dramatic fashion at the time. He was running 8 miles a day now. There was a religious/spiritual component, something profound about the experience and about the therapist. Oy...we'll never make a novelist of you, Clink.

Medical Marijuana on KevinMD

Lockup doc gave us the head's up that KevinMD is also talking about the legalization of marijuana for medical uses. He has good discussion of the issues up, do check it out: Medical Marijuana has Doctors Asking Questions. How'd he know I was asking about this?

The summary comes from HCPLive:

In January, New Jersey became the 14th state in the nation to legalize marijuana use for certain chronic illnesses. Other states where the use of medical marijuana is permitted include Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington; around a dozen more states are weighing pending bills.

The New Jersey law is the most restrictive in the nation and authorizes prescribed marijuana for only a handful of chronic illnesses, such as multiple sclerosis, cancer, glaucoma, epilepsy, Crohn’s disease, AIDS, muscular dystrophy and Lou Gehrig’s disease. Unlike other states, physicians in New Jersey will not be able to prescribe medical marijuana for anxiety, headaches, or chronic pain.

It goes on to discuss the lack of evidence to support uses for medical marijuana, and the obstacles to research:

Despite the Obama administration’s relaxation on prosecutions, many researchers are still having difficulty getting approval to conduct studies that involve smoking marijuana. Requests to conduct the studies must go through the National Institute on Drug Abuse (NIDA), which controls supply from a plantation at the University of Mississippi, the only federally approved source of marijuana. NIDA routinely turns down study requests unless they are designed to evaluate the potential harm from smoking marijuana. The Drug Enforcement Agency has also declined petitions from researchers requesting permission to grow their own marijuana for use in studies.

The article notes that there are some continued issues:

Most states with medical marijuana laws allow employers to refuse employment to individuals who use medical marijuana. In some states, like Colorado, the laws are ambiguous and employers are unclear as to whether they can forbid employees to use medical marijuana outside of work. Schools are also grappling with the issue, as well, with more high school students—particularly in areas with less restrictive medical marijuana laws—receiving prescriptions for marijuana, increasingly to treat ADHD. In addition, some facilities that perform organ transplants acknowledge denying transplants to patients who use medical marijuana.

In the absence of any proven benefits from smoking marijuana, physicians in the 14 states where it is legal may want to discuss some of the pros and cons with their patients prior to issuing a prescription. Patients need to be aware of the potential impact of medical marijuana on all facets of life and should be wary of letting the anecdotal hype surrounding medical marijuana use dissuade them from first trying a proven treatment option.

View the discussion on HCPLive.com.

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On another note, Rach asked us to post the following:

Stan Kutcher at Dalhousie University (Halifax, NS) is asking Canadians for feedback on how to improve infant, child and youth mental health services via an anonymous survey.

https://surveys.dal.ca/opinio/s?s=7808

Going to Pot (or Let's Talk about Medical Marijuana)

Our state is considering legalizing medical marijuana.

As a psychiatrist, my first thought is : NO! We treat addictions, and we try hard not to cause them. Marijuana (and many other illegal substances) may help mood and anxiety in the moment, but they don't seem to fix things for the long haul. And chronic pot smoking decreased motivation, burbles your brain, and does nothing good to your lungs. I have visions of patients at the door saying they need me to prescribe pot for their anxiety. Please, doctor, please.

But then I think of end-stage cancer patients, and it really doesn't bother me if a little cannabis helps with their symptoms.

There are those who claim that oral THC (marinol) can be helpful for many symptoms, oh, but unliked the smoked stuff, Marinol doesn't get you high. There's less evidence about inhaled marijuana being effective.

So here's my question: How does medical marijuana work in your state? How widespread is the use? What are the terms and conditions under which it can be prescribed? Who gets it and with what regulation? Is it a good thing or a bad thing and why? And please, if you have links to data or studies or interesting articles about the legalization of medical marijuana, by all means put them in your comments. If you want to tell me why cannabis should be legal and it's a government plot to keep it illegal and any information from NORML, you can hold off on those links...I think I've heard that side of the story.

Shoveling Up the Mess

This went out on a mass email. I liked it and I decided that since the author wants it disseminated, he wouldn't mind being made a Guest Blogger:

According to a report CASA issued this morning, federal, state and local governments spend almost half a trillion dollars every year -- almost 11 percent of their total budgets -- as a result of alcohol, tobacco and other drug abuse and addiction. The worst part is that, for federal and state spending, about 95% of that money is spent "Shoveling Up" the mess created by a failure to provide enough money for prevention and treatment.

That's right. Out of every dollar federal and state governments spent on substance misuse in 2005 (the latest data available), 95 cents paid for the enormous burden of this problem on health care, criminal justice, child welfare, education, and other programs. And only 2 cents were invested in prevention and treatment programs that could reduce many of these costs -- and save lives.

This huge waste of money is hidden in many different budgets, so most of our elected officials don't have a clue about how much alcohol, tobacco and other drugs really cost taxpayers, and how little governments spend to effectively address the problem. Maybe if they knew, they might do something. You can tell them.

Please do two important things today:

• See detailed expenses for Massachusetts and download the report.
  
  
• Send a message to your governor and state legislators urging them to review and act on the report.
  

Our researchers studied all federal, state and local budgets for 2005 using careful, conservative methods to determine how much of each major budget category was directly linked to substance misuse. For example, they determined how much of each state's Medicaid and other health care expenses were due to one of over 70 medical diagnoses that are caused or made worse by alcohol, tobacco and other drug abuse and addiction. They did the same for criminal justice, welfare and other key government budgets. They also identified all government spending on prevention, treatment and research, regulation of alcohol and tobacco products and drug interdiction.

When the numbers are added up, the total is really shocking: 467.7 billion dollars. Spending less than 2% of the federal and state costs for prevention and treatment, and more than 95% shoveling up the mess, is upside down public policy that wastes billions in taxpayer dollars at a time when resources are scarce, and results in untold human suffering.

Our leaders need to make new investments in prevention and treatment now to reduce the awful burden that untreated tobacco, alcohol and drug problems place on our budgets -- and our citizens.

Please act today.

Sincerely,

David L. Rosenbloom
President and CEO
The National Center on Addiction and Substance Abuse at Columbia University

P.S. Please forward this important message to your friends and colleagues today.

I Didn't Hurt Anybody

I am not a happy ClinkShrink right now. I'm a bit hot under the collar. In fact, I'm a bit hot everywhere right now.

I have no air conditioner. I know, I know, I should be used to this by now. I don't have a phone, I don't have a desk, I have to hunt for chairs to sit on every day. I should be used to this.

I am, I'm just not used to this at home.

This isn't something I typically blog about. I generally keep my personal life off the Internet and stick to mainly professional-type topics, but I promise I will make this relevant to psychiatry.

I called up the local heating and air conditioning guy, who took one look and pointed out what was wrong. He saw it immediately, and I can't believe I didn't.

Someone stole my copper freon pipe. It was four or five feet long, leading from the external pump up into the side of my house. It had been clipped off neatly at either end, so neatly I didn't even notice it was gone. I'm told it's going to take four hours of labor (at an hourly rate nearly 50% higher than what I make as a physician) and four gallons of freon (at $60 per gallon) to fix and there is no guarantee it will work. Depending on how long the pipe was gone, both my external compressor and internal unit may be toast. Replacing both units is ridiculously expensive, not to mention time lost from work and loads of inmates who aren't going to get psychiatric care while I'm out.

I'm going to think about this incident the next time I hear someone say drugs should be decriminalized because drug addicts are only hurting themselves. I will think about this the next time a non-violent substance abuser says, "I'm an addict but I never hurt anybody."

Horse hockey.

Like most people who live in big cities, I've been a victim of crime before. I've also had my car window smashed in by someone looking to steal a bag of used spark plugs (long story). Again, metal recycling is used to support drug addiction. (Maybe we need a registry of people selling metal like we do for pawn shops??) Once upon a time, someone even stole the brass doors off of our circuit court house (200 pounds apiece, metal value estimated at a quarter of a million). Drug addicts don't only hurt themselves and the most hardcore addicts need to be picked up involuntarily and taken off the streets to make them stop using.

So anybody who really wants to debate this is welcome to come over to my place this weekend. The forecast is for a hundred degree heat index.

Bring ice.

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For more on the scrap metal theft epidemic, see also:

How hot are metals?

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Note from Dinah: my guest room has a window unit. You're always welcome