Substance Use Disorder Notes

Michael's Story: Substance Use Disorder

Normal upbringing, excelled in sports and school through middle school.
Early exposure to drugs and alcohol in middle school; developed a non-judgmental view towards substance use.
Started drinking in late middle school or early high school.
Progressed to marijuana use, initially intended to be occasional but became daily.
Mid-high school: Experimentation with cocaine and ecstasy.
Rationalization: "At least I'm not shooting up."
Started skipping school to use drugs; graduated despite declining focus on academics.
First arrest for marijuana possession.
Escalated to regular cocaine and ecstasy use on weekends.
Witnessed friends experiencing severe consequences from drug use (e.g., bad ecstasy pills), which became normalized.

Acquired a good job post-high school and bought a house at 19.
Several years later, sustained work-related injuries.
First experience with Percocet at a party; viewed it as normal since doctors prescribe it for pain.
Awareness of the potential progression from prescription pills to heroin, witnessing family deaths from overdoses.
Rationalization: "This is safe because doctors prescribe it. It won't happen to me."
Developed an addiction to prescription opiates, which became his drug of choice.
Never used heroin or injected drugs but consumed 15-25 Percocet pills daily for about four years.
Required the drug to function, including waking up in the middle of the night to take more.
Neglected work responsibilities (working for his father) if unable to obtain the drug.
Resorted to selling drugs and other unacceptable behaviors to support the addiction.
Damaged relationships with friends and family.
Felt life was on hold due to being "handcuffed" to the drug.

Apprehended by the DEA and faced federal criminal charges, resulting in a felony record.
Friends had been in and out of rehab, but he was resistant to the idea.
Experimented with Suboxone to manage withdrawal symptoms but ultimately used more Percocet to counteract Suboxone's effects.
Offered participation in a unique federal drug court program in New Hampshire.
Considered arrest as rock bottom: While facing up to 30 years in prison, his immediate desire was to get out and use drugs.

The drug court program was effective due to the intensive support and guidance from involved individuals, including his probation officer.
The program had a low completion rate due to its difficulty.
Began making progress in life and realized the destructive nature of his previous lifestyle.
Improved relationships with family members and found support from a grandfather with 35 years of AA experience and a sister with similar experiences.
Previously defiant to seeking help, considering his drug use as almost normal.

Never personally overdosed, but witnessed overdoses among friends.
Narcan is effective if used correctly, but its availability can lead to a false sense of security and potential abuse.
The question of Narcan's accessibility is complex; dispensing to responsible individuals who test negative for drug use might be a solution.
Concerns about users feeling invincible due to Narcan availability.

Exhaust all other options before prescribing opiates due to their addictive nature.
Encourage non-narcotic alternatives.
Closely monitor patients if opiates are necessary, and assess symptom decline.
Inform patients about the potential consequences and the experiences of those who have suffered from opiate addiction.
Provide information and education without being solely punitive, as patients may seek drugs regardless.
Acknowledge the power of these drugs
The false security that comes with prescriptions can be dangerous.
Using responsibly is not something easily achieved with opiates

Addiction can start with just one pill.
The thought that prescribed drugs are inherently safe is misleading.
The experience highlights the power and control that drugs can exert over individuals.
False sense of security due to it being a prescription.
Should have a disclaimer saying it is just as addictive as shooting heroine.